Provider Demographics
NPI:1366878829
Name:SOUTH FLORIDA PREVENTIVE CARE GROUP
Entity type:Organization
Organization Name:SOUTH FLORIDA PREVENTIVE CARE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DNP
Authorized Official - Prefix:DR
Authorized Official - First Name:DEISY
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ-PRIETO
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:305-934-7076
Mailing Address - Street 1:19015 NW 80TH CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5210
Mailing Address - Country:US
Mailing Address - Phone:305-934-7076
Mailing Address - Fax:
Practice Address - Street 1:19015 NW 80TH CT
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5210
Practice Address - Country:US
Practice Address - Phone:305-934-7076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9179779363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty