Basic Information
| Provider Information | |||||||||
| NPI: | 1538540273 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIAZ | ||||||||
| FirstName: | ALVARO | ||||||||
| MiddleName: | E | ||||||||
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| NameSuffix: | JR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8520 SW 133RD AVENUE RD | ||||||||
| Address2: | 314 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331834510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7863128019 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7392 NW 35TH TER | ||||||||
| Address2: | 201 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331221271 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055979494 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2015 | ||||||||
| LastUpdateDate: | 06/17/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | 50-427 | 01 | FL | AHCA TARGATED CASE MANAGEMENT | OTHER |