Provider Demographics
NPI:1710914205
Name:DIEZ, HUGO JR (PHYSICIAN/MD)
Entity Type:Individual
Prefix:MR
First Name:HUGO
Middle Name:
Last Name:DIEZ
Suffix:JR
Gender:M
Credentials:PHYSICIAN/MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11880 SW 40TH ST
Mailing Address - Street 2:SUITE 216
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3584
Mailing Address - Country:US
Mailing Address - Phone:305-552-5792
Mailing Address - Fax:305-552-6119
Practice Address - Street 1:11880 SW 40TH ST
Practice Address - Street 2:SUITE 218
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3584
Practice Address - Country:US
Practice Address - Phone:305-251-3991
Practice Address - Fax:305-251-7982
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0059913207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL053950300Medicaid
FL053950300Medicaid
FL12267Medicare ID - Type Unspecified