Provider Demographics
NPI:1003471178
Name:DIEGUEZ, ANTHONY JOSE (DO)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JOSE
Last Name:DIEGUEZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16470 NE 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-3710
Mailing Address - Country:US
Mailing Address - Phone:305-651-9988
Mailing Address - Fax:
Practice Address - Street 1:16470 NE 10TH AVE
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-3710
Practice Address - Country:US
Practice Address - Phone:305-651-9988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-04
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLOS18592207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program