Individual
DIANA LILIANA SANTIAGO VERGARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5887 GLENRIDGE DR STE 230, SANDY SPRINGS, GA 30328-9929
(305) 785-8573
Mailing address
4300 SW 13TH ST, GAINESVILLE, FL 32608-4006
(352) 374-5600
(352) 374-5608
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
ME102437
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002703000
—
FL
01
—
DK715Z
MEDICARE PTAN
FL
Enumeration date
05/18/2007
Last updated
04/23/2024
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