Provider Demographics
NPI:1548385032
Name:DIAZ PINO, MARGARITA B (MD)
Entity Type:Individual
Prefix:MRS
First Name:MARGARITA
Middle Name:B
Last Name:DIAZ PINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARGARITA
Other - Middle Name:B
Other - Last Name:DIAZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3951 NW 48TH TERRACE
Mailing Address - Street 2:SUITE 121
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606
Mailing Address - Country:US
Mailing Address - Phone:352-336-4000
Mailing Address - Fax:352-366-4140
Practice Address - Street 1:3951 NW 48TH TERRACE
Practice Address - Street 2:SUITE 121
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606
Practice Address - Country:US
Practice Address - Phone:352-336-4000
Practice Address - Fax:352-366-4140
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME585722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
0955058OtherAETNA
FL12353OtherBLUE CROSS BLUE SHIELD
E88775Medicare UPIN
FL12353Medicare ID - Type Unspecified