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General NPI Number Information
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NPI Number | 1215730767
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Entity Type | Individual
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Provider Name | DIEGO A OSORIO GOMEZ PMHNP
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Gender | Male
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Dates
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Enumeration Date | 03/31/2025
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 14162 SW 126TH PL
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City | MIAMI
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State | FL
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Zip | 33186-6093
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Country | US
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Telephone | 847-877-7551
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Fax | 847-496-3880
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Provider Business Mailing Address
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Address Line | 14162 SW 126TH PL
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City | MIAMI
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State | FL
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Zip | 33186-6093
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Country | US
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Telephone |
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Fax | 847-496-3880
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN11038493
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License Number State | FL
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