| Doctor Name: | MARVIN DIAZ-LACAYO |
| NPI Number: | 1871596098 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | ME0022072 |
| Business Practice Address: | 21150 Biscayne Blvd Ste 101 Aventura, FL - 331801226 |
| Business Phone Number: | 3059324198 |
| Business Fax Number: | 3059329102 |
| Mailing Address: | 21150 Biscayne Blvd, Ste 101 AVENTURA |
| State: | FL |
| Postal Code: | 331801226 |
| Phone Number: | 3059324198 |
| Fax Number: | 3059329102 |
| NPI Enumeration Date: | 05/23/2005 |
| NPI Last Update Date: | 12/28/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | 03/15/2006 |
| NPI Reactivation Date: | 03/21/2006 |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | ME0022072 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |