Izquierdo Diaz, Jose Antonio
Izquierdo Diaz, Jose Antonio is an sole proprietor health care provider with primary practice located at 10280 Sw Stephanie Way # 8-101 , Port Saint Lucie FL 34987-1962. He recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Izquierdo Diaz, Jose Antonio can be contacted via phone (786) 389-6304.Contact Information
Primary practice address
10280 Sw Stephanie Way # 8-101
Port Saint Lucie FL 34987-1962
Phone: (786) 389-6304
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Student, Health Care / Student in an Organized Health Care Education/Training Program | 390200000X | 100021299 | New York |
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 130827 | Florida |
Profile Details
| NPI number | 1235534215 |
|---|---|
| LBN Legal business name | Izquierdo Diaz, Jose Antonio |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Nov 3rd, 2014 |
| Last updated | Jul 19th, 2017 - about 8 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1235534215 | NPPES |
| Florida | MEDICAID | 1235534215 |
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