Provider Demographics
NPI:1861693236
Name:DIAZ, VERONICA ASELA (MD)
Entity type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:ASELA
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 S OLD DIXIE HWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7202
Mailing Address - Country:US
Mailing Address - Phone:561-746-7686
Mailing Address - Fax:561-746-3420
Practice Address - Street 1:1002 S OLD DIXIE HWY
Practice Address - Street 2:SUITE 105
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7202
Practice Address - Country:US
Practice Address - Phone:561-746-7686
Practice Address - Fax:561-746-3420
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME104238207XS0106X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDM424YOtherMEDICARE PTAN
FMDM424ZMedicare PIN