Provider Demographics
NPI:1184057275
Name:ESTEBAN J DIAZ RIVERA MD PA
Entity type:Organization
Organization Name:ESTEBAN J DIAZ RIVERA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ESTEBAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DIAZ-RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-835-7502
Mailing Address - Street 1:777 E 25TH ST
Mailing Address - Street 2:SUITE 514
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-3825
Mailing Address - Country:US
Mailing Address - Phone:305-835-7502
Mailing Address - Fax:305-835-7541
Practice Address - Street 1:777 E 25TH ST
Practice Address - Street 2:SUITE 514
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3825
Practice Address - Country:US
Practice Address - Phone:305-835-7502
Practice Address - Fax:305-835-7541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-13
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66676207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty