Provider Demographics
NPI:1710992490
Name:DIEZ-HOECK, GRACIELA (MD)
Entity Type:Individual
Prefix:
First Name:GRACIELA
Middle Name:
Last Name:DIEZ-HOECK
Suffix:
Gender:F
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:PO BOX 45443
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84145-0443
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-376-4107
Practice Address - Street 1:1577 ROBERTS DR STE 224
Practice Address - Street 2:CREDENTIALING DEPARTMENT
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3265
Practice Address - Country:US
Practice Address - Phone:904-249-6940
Practice Address - Fax:904-246-6993
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2018-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70795207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01065783OtherRR MEDICARE
FLG45299Medicare UPIN
FL32264WMedicare PIN