Provider Demographics
NPI:1215976733
Name:DIEGO E. PERNUDI, M.D. AND ASSOCIATES
Entity type:Organization
Organization Name:DIEGO E. PERNUDI, M.D. AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIEGO
Authorized Official - Middle Name:EDUARDO
Authorized Official - Last Name:PERNUDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-554-4830
Mailing Address - Street 1:8260 W FLAGLER ST
Mailing Address - Street 2:SUITE 1K
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2069
Mailing Address - Country:US
Mailing Address - Phone:305-554-4830
Mailing Address - Fax:305-553-7233
Practice Address - Street 1:8260 W FLAGLER ST
Practice Address - Street 2:SUITE 1K
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2069
Practice Address - Country:US
Practice Address - Phone:305-554-4830
Practice Address - Fax:305-553-7233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME45889208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2037105OtherAETNA
FL12189OtherBLUE CROSS/BLUE SHIELD
FL1202009OtherUNITED HEALTH CARE
FL2037105OtherAETNA