Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | DN 14284 | FL |
N | 213EG0000X | General Practice | DN 14284 | FL |
Y | 1223P0700X | Prosthodontist | 14284 | FL |
NPI | 1043392111 |
---|---|
Provider Name | Dr. Federico Diez |
First Address | Weston, FL 33331-3141 |
Second Address | Miramar, FL 33027-2544 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 29/09/2021 |