Provider Demographics
NPI:1376608588
Name:DIAZ-MATOS, MARY-LOUISE (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARY-LOUISE
Middle Name:
Last Name:DIAZ-MATOS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PARK LN
Mailing Address - Street 2:APT. 5C
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-3449
Mailing Address - Country:US
Mailing Address - Phone:914-925-5188
Mailing Address - Fax:914-925-5155
Practice Address - Street 1:1 PARK LN
Practice Address - Street 2:APT. 5C
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-3449
Practice Address - Country:US
Practice Address - Phone:914-925-5188
Practice Address - Fax:914-925-5155
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177367-1163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult