Provider Demographics
NPI:1669595203
Name:DIAZ-JANE, JULIO A (MD)
Entity type:Individual
Prefix:
First Name:JULIO
Middle Name:A
Last Name:DIAZ-JANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 PALM AVE
Mailing Address - Street 2:SUITE SA
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4424
Mailing Address - Country:US
Mailing Address - Phone:305-822-8123
Mailing Address - Fax:305-822-0628
Practice Address - Street 1:4201 PALM AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4424
Practice Address - Country:US
Practice Address - Phone:305-822-8123
Practice Address - Fax:305-822-0628
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0041208207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD63758Medicare UPIN