Provider Information for 1457622714
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JANNIFER A DIAZ
Sex: Female
NPI: 1457622714
Last Updated: 2023-09-20
Certification Date: 2023-09-20
Certification Date: 2023-09-20
Details
| Name | Value | ||||||||||||
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| NPI | 1457622714 | ||||||||||||
| Enumeration Date | 2012-01-19 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 8001 SW 36TH ST SUITE 9 DAVIE, FL 33328-1915 United States Phone: 954-577-7790 | Fax:954-577-7780 | ||||||||||||
| Primary Practice Address | 205 N DIXIE HWY WEST PALM BEACH, FL 33401-4522 United States Phone: 954-744-9190 | Fax: | ||||||||||||
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