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: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1726 MEDICAL BLVD STE 101
NAPLES FL
34110-1426
US

IV. Provider business mailing address

PO BOX 112019
NAPLES FL
34108-0134
US

V. Phone/Fax

Practice location:
  • Phone: 239-624-8250
  • Fax: 239-624-8171
Mailing address:
  • Phone: 239-624-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME144293
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME144293
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: