| Neisa I. Diaz, M.d., L.l.c. | |
|
13501 Icot Blvd Suite 114 Clearwater FL 33760-3729 | |
| (727) 754-7880 | |
| (727) 754-7885 |
| Full Name | Neisa I. Diaz, M.d., L.l.c. |
|---|---|
| Speciality | Internal Medicine |
| Location | 13501 Icot Blvd, Clearwater, Florida |
| Authorized Official Name and Position | Neisa I Diaz (OWNER) |
| Authorized Official Contact | 7277547880 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Neisa I. Diaz, M.d., L.l.c. 13501 Icot Blvd Suite 114 Clearwater FL 33760-3729 Ph: (727) 754-7880 | Neisa I. Diaz, M.d., L.l.c. 13501 Icot Blvd Suite 114 Clearwater FL 33760-3729 Ph: (727) 754-7880 |
| NPI Number | 1659713261 |
|---|---|
| Provider Enumeration Date | 07/24/2013 |
| Last Update Date | 07/24/2013 |
| Medicare PECOS PAC ID | 5193034288 |
|---|---|
| Medicare Enrollment ID | O20151012000292 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659713261 | NPI | - | NPPES |
| 277721500 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 97050 (Florida) | Primary |
| Provider Name | Neisa I Diaz |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1033240510 PECOS PAC ID: 3779675012 Enrollment ID: I20070816000508 |
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