Provider Demographics
NPI:1215959721
Name:VELARDE, DIEGO (MD)
Entity type:Individual
Prefix:DR
First Name:DIEGO
Middle Name:
Last Name:VELARDE
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 1:3165 SUNTREE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-5720
Mailing Address - Country:US
Mailing Address - Phone:321-549-2000
Mailing Address - Fax:321-549-2142
Practice Address - Street 1:3165 SUNTREE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-5720
Practice Address - Country:US
Practice Address - Phone:321-549-2000
Practice Address - Fax:321-549-2142
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94651207RB0002X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL42032OtherBCBS OF FLORIDA
FL049629OtherFLORIDA HEALTH CARE PLANS
FL2568735OtherMULTI PLAN
FL000052100Medicaid
458504OtherWELLCARE
7782074OtherCIGNA
9124167OtherAETNA
P306896OtherFREEDOM HEALTH
01226832OtherAMERIGROUP