Provider Demographics
NPI:1487730891
Name:DIAZ, GERSON PAUL (DC)
Entity type:Individual
Prefix:DR
First Name:GERSON
Middle Name:PAUL
Last Name:DIAZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:10700 CARIBBEAN BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33189-1232
Mailing Address - Country:US
Mailing Address - Phone:305-255-3005
Mailing Address - Fax:305-255-7689
Practice Address - Street 1:10700 CARIBBEAN BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33189-1230
Practice Address - Country:US
Practice Address - Phone:305-255-3005
Practice Address - Fax:305-255-7689
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLCH0006765111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor