Provider Demographics
NPI:1578380408
Name:BACHUR, DIEGO NICOLAS SR
Entity type:Individual
Prefix:
First Name:DIEGO
Middle Name:NICOLAS
Last Name:BACHUR
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 S TREASURE DR APT 4D
Mailing Address - Street 2:
Mailing Address - City:NORTH BAY VILLAGE
Mailing Address - State:FL
Mailing Address - Zip Code:33141-4543
Mailing Address - Country:US
Mailing Address - Phone:786-835-6874
Mailing Address - Fax:
Practice Address - Street 1:7600 SW 87TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3635
Practice Address - Country:US
Practice Address - Phone:305-595-2414
Practice Address - Fax:305-595-5140
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-449246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant