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General NPI Number Information
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NPI Number | 1912261520
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Entity Type | Individual
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Provider Name | BERTHA M. DIEGUEZ-MARINO D.M.D.,M.P.H.
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Gender | Female
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Dates
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Enumeration Date | 06/28/2012
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Last Update Date | 08/27/2012
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Provider Practice Location Address
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Address Line | 316 VALLEY RD
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City | FAIRFIELD
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State | AL
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Zip | 35064-2222
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Country | US
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Telephone | 205-785-3179
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Fax | 205-785-3257
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Provider Business Mailing Address
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Address Line | 2072 CAHABA CREST DR
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City | BIRMINGHAM
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State | AL
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Zip | 35242-4417
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Country | US
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Telephone | 205-785-3179
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Fax | 205-785-3257
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 4224
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License Number State | AL
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