MEDICARE: JORGE DIAZ DE VILLEGAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-26-89041	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073295457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORGE DIAZ DE VILLEGAS

Provider Business Mailing Address
First Line	:	5007 WOODSTONE CIR N
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33463-5821
Country	:	US
Telephone Number	:	786-527-0995
Fax Number	:

Provider Business Practice Location Address
First Line	:	2119 10TH AVE N
Second Line	:
City	:	LAKE WORTH BEACH
State	:	FL
Zip	:	33461-3345
Country	:	US
Telephone Number	:	561-444-2814
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2023
Last Update Date	:	04/08/2026

Similar Medicare Providers

1669526083 — NATIONAL VISION, INC.
Practice Location Address:

3345 SOUTH CONGRESS AVENUE
LAKE WORTH, FL
33461

Practice Phone: 561-964-0220
Practice Fax: 561-940-6680

1134262983 — DR. ERIN S SHANNON OD
Practice Location Address:

3345 S CONGRESS AVE
LAKE WORTH, FL
33461-3020

Practice Phone: 561-964-0220
Practice Fax: 561-964-6680

1730393083 — DR. CATHERINE FIEDLER O D P A
Practice Location Address:

3345 S. CONGRESS AVE
LAKE WORTH, FL
33461

Practice Phone: 561-964-0220
Practice Fax:

1629358577 — MRS. LISSETTE COLLAZO
Practice Location Address:

2115 10TH AVE N
LAKE WORTH BEACH, FL
33461-3345

Practice Phone: 561-506-3665
Practice Fax: 561-444-2458

1376960930 — MACHI MED INC
Practice Location Address:

2121 10TH AVE N
LAKE WORTH, FL
33461-3345

Practice Phone: 561-540-9777
Practice Fax:

1538563796 — SARAH ROLDAN PEDEN MS, BCBA
Practice Location Address:

2115 10TH AVE N
LAKE WORTH BEACH, FL
33461-3345

Practice Phone: 561-506-3665
Practice Fax:

Directions to “ JORGE DIAZ DE VILLEGAS ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.