Provider Demographics
NPI:1932931706
Name:DIAZ MENDEZ, LUIS JUNIOR
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:JUNIOR
Last Name:DIAZ MENDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12820 SW 146TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6358
Mailing Address - Country:US
Mailing Address - Phone:786-378-1171
Mailing Address - Fax:
Practice Address - Street 1:12820 SW 146TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6358
Practice Address - Country:US
Practice Address - Phone:786-378-1171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1179618367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered