Provider Demographics
NPI:1548759434
Name:DIEZ, VICTORIA L (APRN)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:L
Last Name:DIEZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5975 SUNSET DR STE 402
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5198
Mailing Address - Country:US
Mailing Address - Phone:305-669-2833
Mailing Address - Fax:
Practice Address - Street 1:5555 PONCE DE LEON BLVD
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2513
Practice Address - Country:US
Practice Address - Phone:305-284-9100
Practice Address - Fax:305-284-4098
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL9284845363L00000X
FLAPRN9284845363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner