Provider Demographics
NPI:1720058233
Name:RIELO, DIEGO ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:DIEGO
Middle Name:ANTONIO
Last Name:RIELO
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 1:2003 SW 143RD PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-8068
Mailing Address - Country:US
Mailing Address - Phone:305-560-5302
Mailing Address - Fax:305-826-2600
Practice Address - Street 1:17395 NW 59TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5111
Practice Address - Country:US
Practice Address - Phone:305-560-5302
Practice Address - Fax:305-826-2600
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME810402084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2661829-00Medicaid
FL2661829-00Medicaid
E8426Medicare ID - Type Unspecified