Provider Demographics
NPI:1396028346
Name:DIEGO RIELO MD PA
Entity Type:Organization
Organization Name:DIEGO RIELO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIEGO
Authorized Official - Middle Name:
Authorized Official - Last Name:RIELO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-560-5302
Mailing Address - Street 1:2003 SW 143RD PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-8068
Mailing Address - Country:US
Mailing Address - Phone:305-560-5302
Mailing Address - Fax:305-826-2600
Practice Address - Street 1:17395 NW 59TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5111
Practice Address - Country:US
Practice Address - Phone:305-560-5302
Practice Address - Fax:305-826-2600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-27
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME810402084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL29086OtherBCBS
FL266182900Medicaid