Healthcare Provider Details

I. General information

NPI: 1982166328
Provider Name (Legal Business Name): DANIELA SARA DIEGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2019
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 MEADOWS RD
BOCA RATON FL
33486-2349
US

IV. Provider business mailing address

6301 SW 67TH CT
SOUTH MIAMI FL
33143-1915
US

V. Phone/Fax

Practice location:
  • Phone: 561-368-5500
  • Fax:
Mailing address:
  • Phone: 305-491-7526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberME179917
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: