Provider Demographics
NPI:1396513172
Name:DIAZ, ROBERQUIS SR
Entity type:Individual
Prefix:MS
First Name:ROBERQUIS
Middle Name:
Last Name:DIAZ
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 SW 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-2145
Mailing Address - Country:US
Mailing Address - Phone:786-241-5453
Mailing Address - Fax:
Practice Address - Street 1:2560 SW 29TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-2145
Practice Address - Country:US
Practice Address - Phone:786-241-5453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLD265720760580342000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company