Provider Demographics
NPI:1598518128
Name:JORGE L. DIAZ D.O P.A
Entity Type:Organization
Organization Name:JORGE L. DIAZ D.O P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-606-0337
Mailing Address - Street 1:7100 W 20TH AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1811
Mailing Address - Country:US
Mailing Address - Phone:305-821-6112
Mailing Address - Fax:305-821-9050
Practice Address - Street 1:126 E 49TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-1853
Practice Address - Country:US
Practice Address - Phone:305-786-7536
Practice Address - Fax:305-821-9050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center