Healthcare Provider Details

I. General information

NPI: 1720654890
Provider Name (Legal Business Name): DIANA ARAGON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2021
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S ORANGE AVE # MP760-22
ORLANDO FL
32806-2134
US

IV. Provider business mailing address

1400 S ORANGE AVE
ORLANDO FL
32806-2134
US

V. Phone/Fax

Practice location:
  • Phone: 877-876-3627
  • Fax: 321-843-4101
Mailing address:
  • Phone: 877-876-3627
  • Fax: 321-843-4101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9114605
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: