Individual
MARCOS DIAZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5449 S SEMORAN BLVD STE 19B, ORLANDO, FL 32822-1778
(407) 723-5264
(407) 249-4472
Mailing address
6101 LAKE ELLENOR DR, ORLANDO, FL 32809-4616
(407) 858-1400
(407) 858-5529
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
DH29865
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DH29865
MEDICAL LICENSE
FL
Enumeration date
02/20/2023
Last updated
02/20/2023
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