Provider Demographics
NPI:1790993939
Name:CAJAMARCA, DIANA (OD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:CAJAMARCA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 NORWOOD PL
Mailing Address - Street 2:N-110
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6524
Mailing Address - Country:US
Mailing Address - Phone:561-445-9979
Mailing Address - Fax:561-734-2847
Practice Address - Street 1:1000 N CONGRESS AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-3338
Practice Address - Country:US
Practice Address - Phone:561-967-2172
Practice Address - Fax:561-967-2847
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3574152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE6642CMedicare PIN
FLU88163Medicare UPIN