Healthcare Provider Details

I. General information

NPI: 1023011749
Provider Name (Legal Business Name): DIEGO P ANDRADE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 09/29/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9320 US HIGHWAY 301 S
RIVERVIEW FL
33578-6300
US

IV. Provider business mailing address

4048 EVANS AVE STE 303
FT MYERS FL
33901-9390
US

V. Phone/Fax

Practice location:
  • Phone: 813-471-0000
  • Fax: 656-233-5024
Mailing address:
  • Phone: 239-332-5344
  • Fax: 239-332-7246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME0087283
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: