Organization
EDL 66 CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EZEQUIEL DIAZ LOPEZ (OWNER)
(786) 558-9009
Entity
Organization
Contact information
Practice address
4711 NW 79TH AVE STE 6F, DORAL, FL 33166-5439
(786) 558-9009
Mailing address
4711 NW 79TH AVE STE 6F, DORAL, FL 33166-5439
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
01/30/2025
Last updated
03/26/2025
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