Provider Demographics
NPI:1104908508
Name:DIEGUEZ, NORA (PHD)
Entity type:Individual
Prefix:MRS
First Name:NORA
Middle Name:
Last Name:DIEGUEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 142064
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33114-2064
Mailing Address - Country:US
Mailing Address - Phone:305-445-9554
Mailing Address - Fax:786-235-1074
Practice Address - Street 1:100 MIRACLE MILE
Practice Address - Street 2:SUITE 330
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5430
Practice Address - Country:US
Practice Address - Phone:305-445-9554
Practice Address - Fax:786-235-1074
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 000 4487103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73846OtherBLUE CROSS BLUE SHIELD FL
FL73846Medicare ID - Type Unspecified