Provider Demographics
NPI:1306167929
Name:NORA DIEGUEZ PHD PA
Entity type:Organization
Organization Name:NORA DIEGUEZ PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NORA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIEGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:305-445-9554
Mailing Address - Street 1:100 MIRACLE MILE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-5430
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-17
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 4487103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73846OtherBLUE CROSS BLUE SHIELD