Provider Demographics
NPI:1336477009
Name:DIAZ, ROSA LORENIA (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSA
Middle Name:LORENIA
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LORIE
Other - Middle Name:
Other - Last Name:DIAZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 526
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01903-0626
Mailing Address - Country:US
Mailing Address - Phone:781-581-3900
Mailing Address - Fax:
Practice Address - Street 1:269 UNION ST
Practice Address - Street 2:LYNN COMMUNITY HEALTH INC.
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1314
Practice Address - Country:US
Practice Address - Phone:781-581-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-18
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA110461207V00000X
MA252829207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology