Provider Demographics
NPI:1790143972
Name:LUIS A. DIAZ-SECADES, MD, PA
Entity Type:Organization
Organization Name:LUIS A. DIAZ-SECADES, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:DIAZ SECADES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-559-0211
Mailing Address - Street 1:10455 SW 56TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-7060
Mailing Address - Country:US
Mailing Address - Phone:305-559-0211
Mailing Address - Fax:305-559-0966
Practice Address - Street 1:11880 BIRD RD
Practice Address - Street 2:SUITE 210
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3584
Practice Address - Country:US
Practice Address - Phone:305-559-0211
Practice Address - Fax:305-559-0966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME-4129207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty