Provider Demographics
NPI:1700072071
Name:PERNUDI, DIEGO EDUARDO (MD)
Entity Type:Individual
Prefix:
First Name:DIEGO
Middle Name:EDUARDO
Last Name:PERNUDI
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 1:8260 W FLAGLER ST
Mailing Address - Street 2:SUITE 1K
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2069
Mailing Address - Country:US
Mailing Address - Phone:305-554-4830
Mailing Address - Fax:
Practice Address - Street 1:8260 W FLAGLER ST
Practice Address - Street 2:SUITE 1K
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2069
Practice Address - Country:US
Practice Address - Phone:305-554-4830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0045889208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL036872500Medicaid