Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | ME42915 | FL |
NPI | 1093741670 |
---|---|
Provider Name | Javier Diaz Blanco |
First Address | Orlando, FL 32804-4644 |
Second Address | Cocoa Beach, FL 32931-3585 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2006 |
Last Update Date | 28/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
042038700 | (05) | FL |
E04173 | (02) | FL |