Provider Demographics
NPI:1114561172
Name:DIAZ, CAROLINA (MSN)
Entity type:Individual
Prefix:MS
First Name:CAROLINA
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8939 SW 149TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-1438
Mailing Address - Country:US
Mailing Address - Phone:786-777-8734
Mailing Address - Fax:
Practice Address - Street 1:7371 SW 24TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1402
Practice Address - Country:US
Practice Address - Phone:305-265-4441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-03
Last Update Date:2019-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9372860207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine