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Provider Information for 1770579245

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

DR. ODELSA DIAZ ANDRES M.D

Gender: FEMALE

Individual NPI: 1770579245

Calendar   Last Updated:  2017-07-20
  Certification Date: 

Details

Name Value
NPI 1770579245
Enumeration Date 2005-09-21
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 14690 SPRING HILL DR
SPRING HILL, FL 34609-8102
United States

Phone: #(352) 799-0046 | Fax: 352-606-2857
View Map External Link
Primary Practice Address 6279 N LECANTO HWY
BEVERLY HILLS, FL 34465-2503
United States

Phone: 352-522-0094 | Fax: 352-522-0098
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
MEDICAID FL 016457600
Other BLUE CROSS BLUE SHIELD FL V4VMN
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 208D00000X - General Practice FL ACN757