Healthcare Provider Details

I. General information

NPI: 1316321508
Provider Name (Legal Business Name): DIANA P VACA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 01/27/2026
Certification Date: 01/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4651 N STATE ROAD 7 STE 10
COCONUT CREEK FL
33073-4378
US

IV. Provider business mailing address

15392 SW 14TH LN
MIAMI FL
33194-2668
US

V. Phone/Fax

Practice location:
  • Phone: 954-866-5688
  • Fax:
Mailing address:
  • Phone: 917-399-7231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME167285
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: