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NPI Code Detail

MEDICARE: DIANA LILIANA SANTIAGO VERGARA M.D.

MEDICARE: DIANA LILIANA SANTIAGO VERGARA 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
1390200000XStudent in an Organized Health Care Education/Training Program
22084P0800XPsychiatry PhysicianME102437FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1DK715ZOTHERFLMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1588872287
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANA LILIANA SANTIAGO VERGARA M.D.
Provider Business Mailing Address
First Line : 4300 SW 13TH ST
Second Line :
City : GAINESVILLE
State : FL
Zip : 32608-4006
Country : US
Telephone Number : 352-374-5600
Fax Number : 352-374-5608
Provider Business Practice Location Address
First Line : 5887 GLENRIDGE DR STE 230
Second Line :
City : SANDY SPRINGS
State : GA
Zip : 30328-9929
Country : US
Telephone Number : 305-785-8573
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2007
Last Update Date : 04/23/2024

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Directions to “ DIANA LILIANA SANTIAGO VERGARA M.D.” Practice Location

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