Provider Demographics
NPI:1518186469
Name:MANUEL DIEZ, M.D., P.A.
Entity Type:Organization
Organization Name:MANUEL DIEZ, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:DIEZ LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-462-8030
Mailing Address - Street 1:800 E BROWARD BLVD STE 608
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2029
Mailing Address - Country:US
Mailing Address - Phone:954-462-8030
Mailing Address - Fax:954-462-8090
Practice Address - Street 1:800 E BROWARD BLVD STE 608
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2029
Practice Address - Country:US
Practice Address - Phone:954-462-8030
Practice Address - Fax:954-462-8090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME273602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1588767115OtherNPI
FL1588767115OtherNPI