MEDICARE: REINERIO PELEGRINO DIAZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver	P426720623790	FL

General Provider Information

NPI Number	:	1710402169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REINERIO PELEGRINO DIAZ

Provider Business Mailing Address
First Line	:	7828 SAN MIGUEL DR
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-8106
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7828 SAN MIGUEL DR
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-8106
Country	:	US
Telephone Number	:	727-251-3245
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2017
Last Update Date	:	08/07/2017

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Directions to “ REINERIO PELEGRINO DIAZ ” Practice Location

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