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General NPI Number Information
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NPI Number | 1285755132
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Entity Type | Individual
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Provider Name | MARIA- JULIA DIACOVO M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 07/15/2024
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Provider Practice Location Address
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Address Line | 3100 WESTON RD
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City | WESTON
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State | FL
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Zip | 33331-3602
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Country | US
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Telephone | 954-689-5716
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Fax | 954-689-5197
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Provider Business Mailing Address
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Address Line | 2000 METROPICA WAY APT 1803
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City | SUNRISE
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State | FL
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Zip | 33323-3231
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Country | US
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Telephone | 415-516-2437
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Fax |
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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 | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number | 2004015122
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number | ME104397
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License Number State | FL
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