Individual
DIEGO MOGUILLANSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1600 SW ARCHER RD, CONGENITAL HEART CENTER, GAINESVILLE, FL 32610-0296
(352) 273-7517
(352) 392-0547
Mailing address
2563 SW 87TH DR, SUITE 201, GAINESVILLE, FL 32608-9379
(215) 279-1298
(586) 279-1294
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
ME110760
FL
2080P0202X
Pediatric Cardiology Physician
Primary
ME110760
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004148000
—
FL
01
—
ME110760
STATE OF FLORIDA, DEPARTMENT OF HEALTH
FL
Enumeration date
07/13/2009
Last updated
01/23/2012
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