Provider Demographics
NPI:1619065786
Name:DIAZ, ESPERANZA (MD)
Entity Type:Individual
Prefix:DR
First Name:ESPERANZA
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 PARK ST HISPANIC CLINIC
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519
Mailing Address - Country:US
Mailing Address - Phone:203-974-5300
Mailing Address - Fax:203-974-5850
Practice Address - Street 1:34 PARK ST
Practice Address - Street 2:HISPANIC CLINIC
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519
Practice Address - Country:US
Practice Address - Phone:203-974-5300
Practice Address - Fax:203-974-5850
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT262502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry