Provider Demographics
NPI:1609567890
Name:VALDES DIAZ, ABEL
Entity Type:Individual
Prefix:
First Name:ABEL
Middle Name:
Last Name:VALDES DIAZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5871 CORAL WAY
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-2272
Mailing Address - Country:US
Mailing Address - Phone:786-400-3405
Mailing Address - Fax:
Practice Address - Street 1:900 PARK CENTRE BLVD STE 400A
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-5371
Practice Address - Country:US
Practice Address - Phone:305-912-8603
Practice Address - Fax:305-907-5343
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-17
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN1533208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty