Provider Demographics
NPI:1871800664
Name:DIAVANTI, JULIAN (MD)
Entity type:Individual
Prefix:
First Name:JULIAN
Middle Name:
Last Name:DIAVANTI
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 1:8371 SW 124TH AVE APT 105
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-4617
Mailing Address - Country:US
Mailing Address - Phone:786-303-1367
Mailing Address - Fax:
Practice Address - Street 1:1840 W 49TH ST STE 404
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2978
Practice Address - Country:US
Practice Address - Phone:305-828-9980
Practice Address - Fax:786-507-4734
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108115207QA0505X, 208000000X, 2080P0204X, 261QU0200X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency MedicineGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty