Individual
MR. MAIKEL HERNANDEZ DIAZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3435 KAREN AVE, KINGMAN, AZ 86401-6485
(305) 962-2690
Mailing address
30295 N 117TH DR, PEORIA, AZ 85383-8255
(305) 962-2690
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
9107389
FL
Other
Enumeration date
08/28/2013
Last updated
05/21/2019
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