Provider Demographics
NPI:1912768268
Name:LOY DIAZ, AINEL (MD, PA, RDMS)
Entity Type:Individual
Prefix:
First Name:AINEL
Middle Name:
Last Name:LOY DIAZ
Suffix:
Gender:M
Credentials:MD, PA, RDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 NE 2ND ST
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-3561
Mailing Address - Country:US
Mailing Address - Phone:545-446-1699
Mailing Address - Fax:
Practice Address - Street 1:708 NE 2ND ST
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-3561
Practice Address - Country:US
Practice Address - Phone:954-544-6169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTPPA645363A00000X
PR2016-PA363A00000X
FL2584362085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound