Individual
FABIO E SU DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
114 N FLAGLER AVE, POMPANO BEACH, FL 33060-6635
(954) 786-0691
(954) 783-2969
Mailing address
114 N FLAGLER AVE, POMPANO BEACH, FL 33060-6635
(954) 786-0691
(954) 783-2969
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME73893
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
252881900
—
FL
Enumeration date
08/20/2006
Last updated
06/13/2012
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