Boris D Diez, APRN
Individual provider Active NPI Family Medicine Physician · Sweetwater, FL
NPI 1861969883 · NPPES record last updated Dec 7, 2021
Key facts
- NPI
- 1861969883
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- APRN11000018 (FL)
- Practice address
- 1414 NW 107TH Ave Ste 205
Sweetwater, FL 33172-2741 - Phone
- (786) 253-9513
- Fax
- (786) 933-6651
- NPI assigned
- Oct 29, 2018
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190626003155 | FL | Practitioner - Nurse Practitioner | 2860726759 |
Reassigns benefits to 1 organization Practice locations: Homestead, FL; Miami, FL; North Miami Beach, FL |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| APRN11000018 | FL | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Elion Health Corp | Current |
Accepting new patients | |
| Sunbright Health Medical Centers, Inc. | Current |
Accepting new patients | |
| Diez Medical LLC | Family Medicine | Current |
Accepting new patients |
| Health Consulting Associates LLC | Past |
Accepting new patients | |
| PA Surgical Inc | Nurse Practitioner | Past |
Accepting new patients |
Locations
1490 W 49th Pl
Ste 508
Hialeah, FL 33012
Phone (305) 825-9300
15260 SW 280th St
Ste 113
Homestead, FL 33032
Phone (305) 998-7885
1005 N Krome Ave
Ste 121
Homestead, FL 33030
Phone (305) 484-6784
933 SW 122nd Ave
Miami, FL 33184
1414 NW 107th Ave
Ste 205
Sweetwater, FL 33172
Phone (786) 253-9513
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | APRN11000018 | FL | Yes |
| Family Nurse Practitioner | 363LF0000X | APRN11000018 | FL |
Addresses
Primary practice location
1414 NW 107TH Ave Ste 205
Sweetwater, FL 33172-2741
Mailing address
16881 SW 278TH St
Homestead, FL 33031-2745
Phone (786) 253-9513
Other practice location 1
16881 SW 278th St
Homestead, FL 33031-2745
Phone (786) 253-9513
Other providers in Sweetwater, FL
- Derma Beauty Spa Medical Clinic
- Diamond Counseling Services LLC
- Diamond Wellness & Med Center LLC
- Diamond Wellness & Med Center LLC
- Diez Medical LLC
- Dolphin Rehab Center
- Dolphin Rehab Center Inc
- Doral Dental Studio, Inc
- Doral Med and Rehab
- Andres Duarte
All providers in Sweetwater, FL · Family Medicine Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 7, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.