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General NPI Number Information
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NPI Number | 1316940463
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Entity Type | Individual
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Provider Name | JORGE L. DIEZ MD
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Gender | Male
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Dates
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Enumeration Date | 05/23/2005
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Last Update Date | 06/18/2021
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Provider Practice Location Address
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Address Line | 893 MAIN ST STE 202
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City | EAST HARTFORD
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State | CT
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Zip | 06108-2293
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Country | US
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Telephone | 860-247-2137
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Fax | 860-728-0480
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Provider Business Mailing Address
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Address Line | 30 JORDAN LN
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City | WETHERSFIELD
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State | CT
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Zip | 06109-1278
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Country | US
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Telephone | 860-263-0253
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Fax | 860-263-0262
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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 | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 042533
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License Number State | CT
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