Diaz, Jesus Edgardo

Diaz, Jesus Edgardo is an individual health care provider with primary practice located at 1150 45Th St Room L-200, West Palm Beach FL 33407-2361. He recently has only one registered license in Technologists, Technicians & Other Technical Service Providers / Laboratory Management, which is considered as his primary health care specialty. Diaz, Jesus Edgardo can be contacted via phone (561) 514-5360.

Contact Information

Primary practice address
1150 45Th St Room L-200 West Palm Beach FL 33407-2361
Phone: (561) 514-5360
Fax: (561) 514-5550
Website:
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Health care specialties

SpecialtyCodeLicense #State
Technologists, Technicians & Other Technical Service Providers / Laboratory Management 246QL0900X SU28604 Florida

Profile Details

NPI number 1497122022
LBN Legal business name Diaz, Jesus Edgardo
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 31st, 2015
Last updated Aug 31st, 2015 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1497122022 NPPES
Florida MEDICAID 030448400

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