Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | ME108511 | FL |
N | 207QA0505X | Family Doctor - Adult Medicine | ME108511 | FL |
NPI | 1265665145 |
---|---|
Provider Name | Lazaro Roberto Diaz-Nunez |
First Address | Miami, FL 33135-1960 |
Second Address | Miami, FL 33135-1960 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2009 |
Last Update Date | 21/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1265665145 | (05) | FL |