Provider Demographics
NPI:1518942812
Name:DIAZ, MAGDIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MAGDIEL
Middle Name:
Last Name:DIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7650 W FLAGLER ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2406
Mailing Address - Country:US
Mailing Address - Phone:305-269-8099
Mailing Address - Fax:305-261-3250
Practice Address - Street 1:7650 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2406
Practice Address - Country:US
Practice Address - Phone:305-269-8099
Practice Address - Fax:305-261-3250
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84756174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264927600Medicaid
FL264927600Medicaid
FLH69479Medicare UPIN