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General NPI Number Information
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NPI Number | 1720267107
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Entity Type | Organization
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Legal Business Name | GYNECOLOGY SPECIALIST INC.
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Dates
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Enumeration Date | 11/01/2007
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Last Update Date | 11/01/2007
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Provider Practice Location Address
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Address Line | 22 LAKE BEAUTY DR STE. 215
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City | ORLANDO
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State | FL
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Zip | 32806-2037
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Country | US
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Telephone | 407-422-0037
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Fax | 407-423-2535
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Provider Business Mailing Address
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Address Line | 22 LAKE BEAUTY DR STE. 215
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City | ORLANDO
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State | FL
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Zip | 32806-2037
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Country | US
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Telephone | 407-422-0037
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Fax | 407-423-2535
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MAURO EDWARD DIEZ
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Credential | M.D.
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Telephone | 407-422-0037
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME0038697
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License Number State | FL
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