Individual
LEODAN DIAZ ALFONSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
15924 SW 92ND AVE, PALMETTO BAY, FL 33157-1842
(305) 964-5824
Mailing address
15924 SW 92ND AVE, PALMETTO BAY, FL 33157-1842
(305) 964-5824
(786) 452-1200
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
APRN11017005
FL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APRN11017005
FL
Other
Enumeration date
03/03/2023
Last updated
06/12/2024
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