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General NPI Number Information
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NPI Number | 1760882617
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Entity Type | Organization
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Legal Business Name | NEUROLOGY & NEURODIAGNOSTICS LLC
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Dates
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Enumeration Date | 08/28/2014
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 1355 S INTERNATIONAL PKWY SUITE 2451
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City | LAKE MARY
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State | FL
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Zip | 32746-1694
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Country | US
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Telephone | 407-250-3290
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Fax | 407-250-2922
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Provider Business Mailing Address
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Address Line | PO BOX 951316
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City | LAKE MARY
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State | FL
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Zip | 32795-1316
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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 | ADMINISTRATOR
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Name | MARIA DESIREE DIAZ CALDERON
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Credential |
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Telephone | 407-250-3290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | ME109269
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License Number State | FL
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