Provider Demographics
NPI:1275938482
Name:DIAZ GUERRERO, EMMANUEL (MD)
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:
Last Name:DIAZ GUERRERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 E 180TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-3601
Mailing Address - Country:US
Mailing Address - Phone:718-220-0507
Mailing Address - Fax:
Practice Address - Street 1:705 E 180TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-3601
Practice Address - Country:US
Practice Address - Phone:718-220-0507
Practice Address - Fax:718-220-8419
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-30
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY281405208000000X
282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No282NC2000XHospitalsGeneral Acute Care HospitalChildren