Individual
IZADORA IZIDORO DIEHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4700 MILLENIA BOULEVARD, SUITE 175, ORLANDO, FL 32839
(770) 375-7568
Mailing address
3065 DANIELS RD # 1138, WINTER GARDEN, FL 34787-7002
(770) 375-7568
(808) 427-9892
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
2020-00312
NC
208D00000X
General Practice Physician
MD-21547
HI
208D00000X
General Practice Physician
Primary
ME165428
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2020-00312
LICENSE # BY NORTH CAROLINA MEDICAL BOARD
NC
01
—
MD-21547
LICENSE # BY HAWAII MEDICAL BOARD
HI
01
—
ME165428
LICENSE # BY FLORIDA MEDICAL BOARD
FL
Enumeration date
03/28/2018
Last updated
11/17/2023
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