Provider Demographics
NPI:1518317635
Name:DIAZ, GILBERTO (MA)
Entity Type:Individual
Prefix:
First Name:GILBERTO
Middle Name:
Last Name:DIAZ
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87A HORIZON CT
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-0975
Mailing Address - Country:US
Mailing Address - Phone:347-968-6440
Mailing Address - Fax:
Practice Address - Street 1:87A HORIZON CT
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-0975
Practice Address - Country:US
Practice Address - Phone:347-968-6440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst