Provider Demographics
NPI:1649775529
Name:DIAZ, LAURA VANESSA (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:VANESSA
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:900 GLADES RD FL 4
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6407
Mailing Address - Country:US
Mailing Address - Phone:561-430-3933
Mailing Address - Fax:561-430-3943
Practice Address - Street 1:900 GLADES RD FL 4
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6407
Practice Address - Country:US
Practice Address - Phone:561-430-3933
Practice Address - Fax:561-430-3943
Is Sole Proprietor?:No
Enumeration Date:2018-03-24
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME156153207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics