Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | ME0085425 | FL |
NPI | 1295778272 |
---|---|
Provider Name | Jose Diaz |
First Address | Fort Myers, FL 33902-2147 |
Second Address | Fort Myers, FL 33908-3618 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 25/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
265196300 | (05) | FL |