Healthcare Provider Details

I. General information

NPI: 1538238480
Provider Name (Legal Business Name): JOSE A DIAZ BARRIENTOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JOSEPH A DIAZ BARRIENTOS MD

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 03/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 SE 24TH ST ALACHUA COUNTY HEALTH DEPARTMENT
GAINESVILLE FL
32641-7516
US

IV. Provider business mailing address

224 SE 24TH ST
GAINESVILLE FL
32641-7516
US

V. Phone/Fax

Practice location:
  • Phone: 352-334-7910
  • Fax:
Mailing address:
  • Phone: 352-334-7910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number14288
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN759
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: