Provider Demographics
NPI:1487184479
Name:REAL DE ASUA, DIEGO CRISTOBAL (MD, PHD)
Entity Type:Individual
Prefix:MR
First Name:DIEGO
Middle Name:CRISTOBAL
Last Name:REAL DE ASUA
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 E 70TH ST APT 19A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5346
Mailing Address - Country:US
Mailing Address - Phone:646-525-1833
Mailing Address - Fax:
Practice Address - Street 1:435 E 70TH ST APT 19A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5346
Practice Address - Country:US
Practice Address - Phone:646-525-1833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
W229033214OtherAETNA