Individual provider Active NPI

Haley Diaz, PA-C

  • Physician Assistant
  • Pembroke Pines, FL
National Provider Identifier
1326738196
Registry record updated May 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
9117347 Issued in FL
Practice address
130 SW 169TH Ave
Pembroke Pines, FL 33027-1006
Phone
(786) 901-2972
NPI assigned
May 15, 2023
Last updated
May 15, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 9117347 FL Primary

Addresses

Primary practice location

130 SW 169TH Ave
Pembroke Pines, FL 33027-1006

Mailing address

130 SW 169TH Ave
Pembroke Pines, FL 33027-1006
Phone (786) 901-2972

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230711003590 FL Practitioner - Physician Assistant 3274991542 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
9117347FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
M Partners, LLC CurrentSince May 1, 2024 Accepting new patients
M Partners, LLC CurrentSince May 1, 2024 Accepting new patients
Mindpath Health Florida, PLLC Physician Assistant Past Accepting new patients

Locations

9400 Bonita Beach Rd SE
Ste 201
Bonita Springs, FL 34135
Phone (239) 597-5530

15275 Collier Blvd
#201291
Naples, FL 34119

1164 E Oakland Park Blvd
Ste 201
Oakland Park, FL 33334
Phone (954) 628-3350

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1684108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684108800000",
    "number": "1326738196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 SW 169TH AVE",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330271006",
            "telephone_number": "786-901-2972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 SW 169TH AVE",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330271006",
            "telephone_number": "786-901-2972"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIAZ",
        "first_name": "HALEY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-15",
        "last_updated": "2023-05-15",
        "certification_date": "2023-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "9117347",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pembroke Pines, FL

Sources for this page

Verify at the official NPI Registry.