Provider Demographics
NPI:1073018586
Name:DIAZ-HERNANDEZ, XAVIER EMILIO ACOSTA (MD)
Entity type:Individual
Prefix:DR
First Name:XAVIER
Middle Name:EMILIO ACOSTA
Last Name:DIAZ-HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SAINT ELIZABETH WAY STE 110
Mailing Address - Street 2:
Mailing Address - City:ST JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-1153
Mailing Address - Country:US
Mailing Address - Phone:904-691-9100
Mailing Address - Fax:
Practice Address - Street 1:300 SAINT ELIZABETH WAY STE 110
Practice Address - Street 2:
Practice Address - City:ST JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259
Practice Address - Country:US
Practice Address - Phone:046-919-1009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME173656207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program