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Individual

MR. JESUS EDGARDO DIAZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
1150 45TH ST, ROOM L-200, WEST PALM BEACH, FL 33407-2361
(561) 514-5360
(561) 514-5550
Mailing address
1150 45TH ST, ROOM L-200, WEST PALM BEACH, FL 33407-2361
(561) 514-5360
(561) 514-5550

Taxonomy

Speciality
Code
Description
License number
State
246QL0900X
Laboratory Management Specialist/Technologist
Primary
SU28604
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
030448400
FL
Enumeration date
08/31/2015
Last updated
08/31/2015
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