Provider Demographics
NPI:1861400046
Name:DIEZ, MAURO EDWARD (MD)
Entity type:Individual
Prefix:MR
First Name:MAURO
Middle Name:EDWARD
Last Name:DIEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2712 S FERN CREEK AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-5539
Mailing Address - Country:US
Mailing Address - Phone:407-422-0037
Mailing Address - Fax:407-423-2535
Practice Address - Street 1:2712 S FERN CREEK AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-5539
Practice Address - Country:US
Practice Address - Phone:407-422-0037
Practice Address - Fax:407-423-2535
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2025-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME38697207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
260609255OtherTAX ID
FL47630Medicare ID - Type Unspecified