Provider Demographics
NPI:1053795815
Name:DIAZ MEDICAL CENTER, INC.
Entity type:Organization
Organization Name:DIAZ MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUESCH
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:813-385-8089
Mailing Address - Street 1:303 BRYAN RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5342
Mailing Address - Country:US
Mailing Address - Phone:813-684-6867
Mailing Address - Fax:
Practice Address - Street 1:303 BRYAN RD
Practice Address - Street 2:SUITE 1
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5342
Practice Address - Country:US
Practice Address - Phone:813-684-6867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-11
Last Update Date:2015-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care