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NPI Code Detail

MEDICARE: DR. JORGE ANDRES DIAZ M.D.

MEDICARE: DR. JORGE ANDRES DIAZ M.D.
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
12084P0800XPsychiatry PhysicianME131930FL
22084P0804XChild & Adolescent Psychiatry PhysicianME131930FL

General Provider Information

NPI Number : 1578978342
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JORGE ANDRES DIAZ M.D.
Provider Business Mailing Address
First Line : 90 FORT WADE RD STE 100
Second Line :
City : PONTE VEDRA
State : FL
Zip : 32081-5114
Country : US
Telephone Number : 904-466-8916
Fax Number : 904-302-6954
Provider Business Practice Location Address
First Line : 90 FORT WADE RD STE 100
Second Line :
City : PONTE VEDRA BEACH
State : FL
Zip : 32081-5114
Country : US
Telephone Number : 904-466-8916
Fax Number : 904-302-6954
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2014
Last Update Date : 08/13/2025

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