Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | OS9686 | FL |
N | 2081P2900X | Pain Medicine | OS9686 | FL |
NPI | 1164535753 |
---|---|
Provider Name | Jose Juan Diaz |
First Address | Ft Lauderdale, FL 33308-6906 |
Second Address | Ft Lauderdale, FL 33308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 15/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I48439 | (02) |