Healthcare Provider Details

I. General information

NPI: 1598871014
Provider Name (Legal Business Name): HECTOR JOSE DIAZ DE VILLEGAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2135 S CONGRESS AVE SUITE: 2C-D
PALM SPRINGS FL
33406-7611
US

IV. Provider business mailing address

2135 S CONGRESS AVE SUITE: 2C-D
PALM SPRINGS FL
33406-7611
US

V. Phone/Fax

Practice location:
  • Phone: 561-432-1822
  • Fax: 561-432-0108
Mailing address:
  • Phone: 561-432-1822
  • Fax: 561-432-0108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0063404
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: