Provider Demographics
NPI:1447681846
Name:DIEGUEZ, BERTAMARIA (MD)
Entity type:Individual
Prefix:
First Name:BERTAMARIA
Middle Name:
Last Name:DIEGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 SHORE DR W
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-2627
Mailing Address - Country:US
Mailing Address - Phone:305-799-0577
Mailing Address - Fax:
Practice Address - Street 1:7800 SW 87TH AVE # B260
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3570
Practice Address - Country:US
Practice Address - Phone:305-595-4590
Practice Address - Fax:305-279-2278
Is Sole Proprietor?:No
Enumeration Date:2013-12-10
Last Update Date:2018-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME128658207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease