Basic Information
| Provider Information | |||||||||
| NPI: | 1598340606 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RETINA CONSULTANTS OF MIAMI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 950 BRICKELL BAY DR APT 5007 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331313963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3057946117 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2601 SW 37TH AVE STE 907 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331332751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3057126711 | ||||||||
| FaxNumber: | 3057604719 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2021 | ||||||||
| LastUpdateDate: | 04/11/2022 | ||||||||
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| AuthorizedOfficialLastName: | DIAZ | ||||||||
| AuthorizedOfficialFirstName: | JOSE | ||||||||
| AuthorizedOfficialMiddleName: | DANIEL | ||||||||
| AuthorizedOfficialTitleorPosition: | MAIN PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 3057126711 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 04/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207WX0107X | Y | 193400000X SINGLE SPECIALTY GROUP |
No ID Information.