Provider Demographics
NPI:1568613479
Name:DIAZ, DEBORAH JANE (PAC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:JANE
Last Name:DIAZ
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 S SEACREST BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-7943
Mailing Address - Country:US
Mailing Address - Phone:561-734-2746
Mailing Address - Fax:561-734-4705
Practice Address - Street 1:2800 S SEACREST BLVD STE 140
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-7943
Practice Address - Country:US
Practice Address - Phone:561-734-2746
Practice Address - Fax:561-734-4705
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104741363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9104741OtherMEDICAL LICENSE