Provider Demographics
NPI:1598871014
Name:DIAZ DE VILLEGAS, HECTOR JOSE
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:JOSE
Last Name:DIAZ DE VILLEGAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2135 S CONGRESS AVE
Mailing Address - Street 2:SUITE: 2C-D
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33406-7611
Mailing Address - Country:US
Mailing Address - Phone:561-432-1822
Mailing Address - Fax:561-432-0108
Practice Address - Street 1:2135 S CONGRESS AVE
Practice Address - Street 2:SUITE: 2C-D
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33406-7611
Practice Address - Country:US
Practice Address - Phone:561-432-1822
Practice Address - Fax:561-432-0108
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0063404208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379462800Medicaid