Provider Demographics
NPI:1578532800
Name:DIAZ, PEDRO O (MD)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:O
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 1:2387 W 68TH ST
Mailing Address - Street 2:SUITE 503
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-6889
Mailing Address - Country:US
Mailing Address - Phone:305-558-0720
Mailing Address - Fax:305-558-8847
Practice Address - Street 1:2387 W 68TH ST
Practice Address - Street 2:SUITE 503
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-6889
Practice Address - Country:US
Practice Address - Phone:305-558-0720
Practice Address - Fax:305-558-8847
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 0048134207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL045298000Medicaid
FLD61007Medicare UPIN
FL04066MMedicare ID - Type UnspecifiedMEDICARE INDIVIDUAL