Provider Demographics
NPI:1285755132
Name:DIACOVO, MARIA- JULIA (MD)
Entity type:Individual
Prefix:
First Name:MARIA- JULIA
Middle Name:
Last Name:DIACOVO
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 1:2000 METROPICA WAY APT 1803
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-3231
Mailing Address - Country:US
Mailing Address - Phone:415-516-2437
Mailing Address - Fax:
Practice Address - Street 1:3100 WESTON RD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3602
Practice Address - Country:US
Practice Address - Phone:954-689-5716
Practice Address - Fax:954-689-5197
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004015122207ZP0101X
FLME104397207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology