Healthcare Provider Details

I. General information

NPI: 1922567890
Provider Name (Legal Business Name): PEDRO JOSE ONDINA-DIAZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12301 LEXINGTON PARK DR APT 205
WESTCHASE FL
33626-2733
US

IV. Provider business mailing address

12301 LEXINGTON PARK DR APT 205
WESTCHASE FL
33626-2733
US

V. Phone/Fax

Practice location:
  • Phone: 787-619-9401
  • Fax: 813-916-2944
Mailing address:
  • Phone: 787-619-9401
  • Fax: 813-916-2944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101285672
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME158337
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number104750
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: