Provider Demographics
NPI:1497559868
Name:DIAZ, ILIANA (APRN)
Entity type:Individual
Prefix:
First Name:ILIANA
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16340 NW 59TH AVE # 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-5601
Mailing Address - Country:US
Mailing Address - Phone:786-266-4982
Mailing Address - Fax:786-266-4982
Practice Address - Street 1:16340 NW 59TH AVE # 200
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-5601
Practice Address - Country:US
Practice Address - Phone:786-266-4982
Practice Address - Fax:786-266-4982
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-03
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9373837207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine