Provider Demographics
NPI:1790314177
Name:DIEZ, DANIEL ESTEBAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ESTEBAN
Last Name:DIEZ
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 1:13806 LITTLE RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-8025
Mailing Address - Country:US
Mailing Address - Phone:727-857-4753
Mailing Address - Fax:727-857-3261
Practice Address - Street 1:13806 LITTLE RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-8025
Practice Address - Country:US
Practice Address - Phone:727-857-4753
Practice Address - Fax:727-857-3261
Is Sole Proprietor?:No
Enumeration Date:2020-04-07
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME160547207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine