MEDICARE: DR. PEDRO JOSE ONDINA-DIAZ MD

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	2085R0202X	Diagnostic Radiology Physician	0101285672	VA
2	2085R0202X	Diagnostic Radiology Physician	ME158337	FL
3	2085R0202X	Diagnostic Radiology Physician	104750	GA

General Provider Information

NPI Number	:	1922567890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PEDRO JOSE ONDINA-DIAZ MD

Provider Business Mailing Address
First Line	:	PO BOX 100374
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32610-0374
Country	:	US
Telephone Number	:	352-265-0291
Fax Number	:	352-265-0279

Provider Business Practice Location Address
First Line	:	12301 LEXINGTON PARK DR APT 205
Second Line	:
City	:	WESTCHASE
State	:	FL
Zip	:	33626-2733
Country	:	US
Telephone Number	:	787-619-9401
Fax Number	:	813-916-2944

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

Provider Enumeration Date	:	03/19/2019
Last Update Date	:	04/24/2026

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