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General NPI Number Information
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NPI Number | 1710402169
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Entity Type | Individual
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Provider Name | REINERIO PELEGRINO DIAZ
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Gender | Male
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Dates
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Enumeration Date | 08/07/2017
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Last Update Date | 08/07/2017
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Provider Practice Location Address
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Address Line | 7828 SAN MIGUEL DR
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City | PORT RICHEY
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State | FL
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Zip | 34668-8106
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Country | US
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Telephone | 727-251-3245
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Fax |
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Provider Business Mailing Address
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Address Line | 7828 SAN MIGUEL DR
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City | PORT RICHEY
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State | FL
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Zip | 34668-8106
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Country | US
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Telephone |
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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 | 172A00000X
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Taxonomy Name | Driver
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License Number | P426720623790
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License Number State | FL
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