Provider Demographics
NPI:1942659842
Name:DIAZ, FERNANDO ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:ANTONIO
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 1:2974 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-2827
Mailing Address - Country:US
Mailing Address - Phone:305-631-3000
Mailing Address - Fax:305-631-3006
Practice Address - Street 1:2974 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2827
Practice Address - Country:US
Practice Address - Phone:305-631-3000
Practice Address - Fax:305-631-3006
Is Sole Proprietor?:No
Enumeration Date:2016-06-10
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS3377207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine