MEDICARE: DR. JORGE CESAR 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
1	2084P0804X	Child & Adolescent Psychiatry Physician	ME126524	FL
2	2084P0800X	Psychiatry Physician	ME126524	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
2	PUHZ6	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1679811657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORGE CESAR DIAZ M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2147
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33902-2147
Country	:	US
Telephone Number	:	239-343-6050
Fax Number	:	239-343-6051

Provider Business Practice Location Address
First Line	:	414 CAPE CORAL PKWY E STE 104
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-8522
Country	:	US
Telephone Number	:	239-343-6050
Fax Number	:	239-468-7946

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

Provider Enumeration Date	:	01/24/2013
Last Update Date	:	10/15/2025

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Directions to “ DR. JORGE CESAR DIAZ M.D.” Practice Location

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