Izadora Izidoro Diehl, MD

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

ME165428 Issued in FL

Practice address

4700 Millenia Boulevard
Suite 175
Orlando, FL 32839

Phone

(770) 375-7568

NPI assigned

Mar 28, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 3

Other names 1

• Izadora Porto Izidoro Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

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": "1522195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700179200000",
    "number": "1780189902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3065 DANIELS RD # 1138",
            "city": "WINTER GARDEN",
            "state": "FL",
            "postal_code": "347877002",
            "telephone_number": "770-375-7568",
            "fax_number": "808-427-9892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 MILLENIA BOULEVARD",
            "address_2": "SUITE 175",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "32839",
            "telephone_number": "770-375-7568"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5128 Silabert Ave",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282057863",
            "country_code": "US",
            "telephone_number": "770-375-7568",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DIEHL",
        "first_name": "IZADORA",
        "middle_name": "IZIDORO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-28",
        "last_updated": "2023-11-17",
        "certification_date": "2023-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "FL",
            "license": "ME165428",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "HI",
            "license": "MD-21547",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NC",
            "license": "2020-00312",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE # BY FLORIDA MEDICAL BOARD",
            "identifier": "ME165428",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE # BY HAWAII MEDICAL BOARD",
            "identifier": "MD-21547",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE # BY NORTH CAROLINA MEDICAL BOARD",
            "identifier": "2020-00312",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "IZADORA",
            "last_name": "IZIDORO",
            "middle_name": "PORTO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Frank Clinton Diefenderfer, D.D.S., P.A.
• Kelley Lauren Diefenderfer, FNP-C, ARNP
• Diego Pagan
• Dayamis Dieguez
• Yuleidi Dieguez, FNP-C
• Kristen A Diehl, PA-C
• Matthew Paul Diehl, PA-C
• Rebecca Helene Diem, MSN, APRN, FNP-C
• Ndeye Codou Dieng, CRNA
• Adrienne L Dienst, OTR/L

• General Practice Physician in Orlando, FL
• Providers in Orlando, FL by specialty
• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.