Provider Demographics
NPI:1669519898
Name:DIAZ, JESUS MARIO (HAS-NBC-HIS)
Entity type:Individual
Prefix:MR
First Name:JESUS
Middle Name:MARIO
Last Name:DIAZ
Suffix:
Gender:M
Credentials:HAS-NBC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8870 SW 40TH ST
Mailing Address - Street 2:SUITE #7
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-5465
Mailing Address - Country:US
Mailing Address - Phone:786-621-4253
Mailing Address - Fax:786-621-4254
Practice Address - Street 1:8870 SW 40TH ST
Practice Address - Street 2:SUITE #7
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-5465
Practice Address - Country:US
Practice Address - Phone:786-621-4253
Practice Address - Fax:786-621-4254
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS2802237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist