Basic Information
Provider Information
NPI: 1376165183
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ABRAHAM DIAZ
FirstName: ALOINA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8761 SW 27TH ST
Address2:  
City: MIAMI
State: FL
PostalCode: 331653201
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 654 NE 9TH PL
Address2:  
City: HOMESTEAD
State: FL
PostalCode: 330304934
CountryCode: US
TelephoneNumber: 3052483488
FaxNumber: 3052486558
Other Information
ProviderEnumerationDate: 05/14/2020
LastUpdateDate: 05/14/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/14/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106S00000XRBT-20-117273FLY    

No ID Information.


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