Provider Demographics
NPI:1134175086
Name:DIAZ, RINA M (MD)
Entity type:Individual
Prefix:DR
First Name:RINA
Middle Name:M
Last Name:DIAZ
Suffix:
Gender:F
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:PO BOX 1830
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33757-1830
Mailing Address - Country:US
Mailing Address - Phone:727-532-0002
Mailing Address - Fax:727-532-1318
Practice Address - Street 1:1700 66TH ST N
Practice Address - Street 2:SUITE 403
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-5544
Practice Address - Country:US
Practice Address - Phone:727-344-2355
Practice Address - Fax:727-344-7166
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68784207Q00000X
NY276702207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03951035Medicaid
FL250083300Medicaid
FLP00305540OtherRAILROAD MEDICARE NUMBER
FL27359UMedicare PIN
NYA400112099Medicare PIN
FLP00305540OtherRAILROAD MEDICARE NUMBER
NY03951035Medicaid