Provider Demographics
NPI:1427355221
Name:DIAZ JANE OB GYN PA
Entity type:Organization
Organization Name:DIAZ JANE OB GYN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:ANDRES
Authorized Official - Last Name:DIAZ-JANE
Authorized Official - Suffix:
Authorized Official - Credentials:M,D
Authorized Official - Phone:305-822-8123
Mailing Address - Street 1:777 E 25TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-3825
Mailing Address - Country:US
Mailing Address - Phone:305-822-8123
Mailing Address - Fax:305-822-0628
Practice Address - Street 1:777 E 25TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3825
Practice Address - Country:US
Practice Address - Phone:305-822-8123
Practice Address - Fax:305-822-0628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-15
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZME41208174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067859700Medicaid
FL96092AMedicare UPIN