Provider Demographics
NPI:1639973928
Name:DIAZ, DAVID EMMANUEL SR
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:EMMANUEL
Last Name:DIAZ
Suffix:SR
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-6718
Mailing Address - Country:US
Mailing Address - Phone:347-453-7051
Mailing Address - Fax:
Practice Address - Street 1:602 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-6718
Practice Address - Country:US
Practice Address - Phone:347-453-7051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver