Provider Demographics
NPI:1427254689
Name:LUIS G DIAZ RANGEL MD PA
Entity type:Organization
Organization Name:LUIS G DIAZ RANGEL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:G
Authorized Official - Last Name:DIAZ RANGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-693-1988
Mailing Address - Street 1:777 E 25TH ST STE 118
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-3804
Mailing Address - Country:US
Mailing Address - Phone:305-693-1988
Mailing Address - Fax:305-693-3941
Practice Address - Street 1:777 E 25TH ST STE 118
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3804
Practice Address - Country:US
Practice Address - Phone:305-693-1988
Practice Address - Fax:305-693-3941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0052014207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275393600Medicaid
FL17703Medicare ID - Type UnspecifiedPROVIDER NUMBER
FL275393600Medicaid
FLK6067Medicare ID - Type Unspecified