Provider Demographics
NPI:1578527529
Name:DIAZ BOLANO, HERNAN (MD)
Entity Type:Individual
Prefix:DR
First Name:HERNAN
Middle Name:
Last Name:DIAZ BOLANO
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 1:8200 MILLER DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-5423
Mailing Address - Country:US
Mailing Address - Phone:305-271-6466
Mailing Address - Fax:305-271-6722
Practice Address - Street 1:8600 SW 92ND ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7397
Practice Address - Country:US
Practice Address - Phone:305-271-6466
Practice Address - Fax:305-271-6722
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44883207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL96938Medicare ID - Type UnspecifiedMEDICARE NUMBER