Healthcare Provider Details

I. General information

NPI: 1215976733
Provider Name (Legal Business Name): DIEGO E. PERNUDI, M.D. AND ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8260 W FLAGLER ST SUITE 1K
MIAMI FL
33144-2069
US

IV. Provider business mailing address

8260 W FLAGLER ST SUITE 1K
MIAMI FL
33144-2069
US

V. Phone/Fax

Practice location:
  • Phone: 305-554-4830
  • Fax: 305-553-7233
Mailing address:
  • Phone: 305-554-4830
  • Fax: 305-553-7233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME45889
License Number StateFL

VIII. Authorized Official

Name: DIEGO EDUARDO PERNUDI
Title or Position: PRESIDENT
Credential:
Phone: 305-554-4830