Jorge Andres Diaz, M.D.

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

ME131930 Issued in FL

Practice address

90 Fort Wade Rd Ste 100
Ponte Vedra Beach, FL 32081-5114

Phone

(904) 466-8916

Fax

(904) 302-6954

NPI assigned

Jun 30, 2014

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1404086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755043200000",
    "number": "1578978342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 FORT WADE RD STE 100",
            "city": "PONTE VEDRA",
            "state": "FL",
            "postal_code": "320815114",
            "telephone_number": "904-466-8916",
            "fax_number": "904-302-6954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 FORT WADE RD STE 100",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320815114",
            "telephone_number": "904-466-8916",
            "fax_number": "904-302-6954"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "248 Southpark Cir E",
            "address_purpose": "LOCATION",
            "city": "Saint Augustine",
            "state": "FL",
            "postal_code": "320865137",
            "country_code": "US",
            "telephone_number": "904-466-8916",
            "fax_number": "904-302-6954",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DIAZ",
        "first_name": "JORGE",
        "middle_name": "ANDRES",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-06-30",
        "last_updated": "2025-08-13",
        "certification_date": "2025-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "ME131930",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "FL",
            "license": "ME131930",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Michael Dellaporta, D.M.D.
• Desmond Bell, DPM. CWS, P.a.
• Melanie P Desmond, M.A. SLP-CCC
• Carolyn Irene Dewane, RD,LD
• Diagnostic Imaging PA
• Cheryl Anne Dietly
• Michaela Mayol Dimain, APRN
• Adam Dimitrov, MD
• Andrea Distefano, FNP-BC
• Sarah Marie Dodds, OTR/L

• Child & Adolescent Psychiatry Physician in Ponte Vedra Beach, FL
• Providers in Ponte Vedra Beach, FL by specialty
• Child & Adolescent Psychiatry Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.