Provider Demographics
NPI:1659254043
Name:AMPUDIA, DIARENNI I
Entity type:Individual
Prefix:
First Name:DIARENNI
Middle Name:
Last Name:AMPUDIA
Suffix:I
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 SW 44TH AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33317-5766
Mailing Address - Country:US
Mailing Address - Phone:754-245-3875
Mailing Address - Fax:
Practice Address - Street 1:1730 SW 44TH AVE APT 2
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33317-5766
Practice Address - Country:US
Practice Address - Phone:754-245-3875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-31
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL246Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health Information