Provider Demographics
NPI:1679661722
Name:DIEGUEZ, CARLOS M (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:M
Last Name:DIEGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 W COLONIAL DR STE 387
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-3435
Mailing Address - Country:US
Mailing Address - Phone:407-635-3370
Mailing Address - Fax:407-636-7818
Practice Address - Street 1:10000 W COLONIAL DR STE 387
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-3435
Practice Address - Country:US
Practice Address - Phone:407-635-3370
Practice Address - Fax:407-636-7818
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 44665207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL06344OtherSTAYWELL
FL069787700Medicaid
FL47658VMedicare PIN
FL06344OtherSTAYWELL