MEDICARE: MRS. GRISELL CARIDAD DIAZ DEVILLEGAS MD

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	208000000X	Pediatrics Physician	ME0068858	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821069238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GRISELL CARIDAD DIAZ DEVILLEGAS MD

Provider Business Mailing Address
First Line	:	2135 S CONGRESS AVE
Second Line	:	BLDG 2 SUITE A B
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406
Country	:	US
Telephone Number	:	561-641-0811
Fax Number	:	561-641-0813

Provider Business Practice Location Address
First Line	:	2135 S CONGRESS AVE
Second Line	:	BLDG 2 SUITE A B
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406
Country	:	US
Telephone Number	:	561-641-0811
Fax Number	:	561-641-0813

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

Provider Enumeration Date	:	02/01/2006
Last Update Date	:	08/25/2011

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