Provider Demographics
NPI:1720267107
Name:GYNECOLOGY SPECIALIST INC.
Entity Type:Organization
Organization Name:GYNECOLOGY SPECIALIST INC.
Other - Org Name:THE DIEZ CENTRE FOR WOMEN'S WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURO
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DIEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-422-0037
Mailing Address - Street 1:22 LAKE BEAUTY DR
Mailing Address - Street 2:STE. 215
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2037
Mailing Address - Country:US
Mailing Address - Phone:407-422-0037
Mailing Address - Fax:407-423-2535
Practice Address - Street 1:22 LAKE BEAUTY DR
Practice Address - Street 2:STE. 215
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2037
Practice Address - Country:US
Practice Address - Phone:407-422-0037
Practice Address - Fax:407-423-2535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0038697174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD55125Medicare UPIN
FL47630Medicare PIN