Basic Information
| Provider Information | |||||||||
| NPI: | 1922594167 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIAZ | ||||||||
| FirstName: | OMAR | ||||||||
| MiddleName: | RAMOS | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MSN, NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30575 BAINBRIDGE RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | SOLON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441392275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4403686868 | ||||||||
| FaxNumber: | 4403686866 | ||||||||
| Practice Location | |||||||||
| Address1: | 30575 BAINBRIDGE RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | SOLON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441392275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4403686868 | ||||||||
| FaxNumber: | 4403686866 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2018 | ||||||||
| LastUpdateDate: | 07/23/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | APRN.CNP.023101 | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LG0600X | APRN.CNP.023101 | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology | 363L00000X | APRN.CNP.023101 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.