Provider Demographics
NPI:1679297022
Name:DIAZ, LUIS MANUEL (RN)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:MANUEL
Last Name:DIAZ
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2793 W 72ND PL
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5436
Mailing Address - Country:US
Mailing Address - Phone:786-447-5932
Mailing Address - Fax:
Practice Address - Street 1:790 NW 107TH AVE STE 301
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-3160
Practice Address - Country:US
Practice Address - Phone:786-518-3353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9569238163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse