Individual
DR. DIANA SOFIA GLACCUM-GAVAGNI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
900 SW 196TH AVE, PEMBROKE PINES, FL 33029-1329
(954) 546-2707
(305) 355-7195
Mailing address
20984 UPTOWN AVE APT 105, BOCA RATON, FL 33428-6579
(954) 546-2707
(954) 820-5592
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
ME105239
FL
2084P0804X
Child & Adolescent Psychiatry Physician
ME105239
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001754800
—
FL
Enumeration date
05/29/2007
Last updated
04/11/2025
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