Provider Demographics
NPI:1891068300
Name:FERNANDO N DIAZ, MD. PA
Entity type:Organization
Organization Name:FERNANDO N DIAZ, MD. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:N
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-987-8183
Mailing Address - Street 1:3990 SHERIDAN STREET. SUITE 206
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3656
Mailing Address - Country:US
Mailing Address - Phone:954-987-8183
Mailing Address - Fax:954-894-9937
Practice Address - Street 1:3990 SHERIDAN ST STE 206
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3656
Practice Address - Country:US
Practice Address - Phone:954-987-8183
Practice Address - Fax:954-894-9937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL93836Medicare PIN
FLD64621Medicare UPIN