Healthcare Provider Details

I. General information

NPI: 1831321942
Provider Name (Legal Business Name): DIEGO JOSE HEREDIA VINTIMILLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2009
Last Update Date: 09/11/2025
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 9TH ST N STE 304
NAPLES FL
34102-5887
US

IV. Provider business mailing address

3245 HEALTH DR STE 100
GRANGER IN
46530-1380
US

V. Phone/Fax

Practice location:
  • Phone: 239-624-8250
  • Fax: 239-624-8171
Mailing address:
  • Phone: 574-647-1840
  • Fax: 574-237-6069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME144293
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: