Provider Demographics
NPI:1629212790
Name:RATZLAFF, DIEGO HERNAN (PA)
Entity Type:Individual
Prefix:MR
First Name:DIEGO
Middle Name:HERNAN
Last Name:RATZLAFF
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 31ST ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11232-1803
Mailing Address - Country:US
Mailing Address - Phone:646-331-5911
Mailing Address - Fax:
Practice Address - Street 1:271 DOUGHTY BLVD
Practice Address - Street 2:
Practice Address - City:INWOOD
Practice Address - State:NY
Practice Address - Zip Code:11096-2135
Practice Address - Country:US
Practice Address - Phone:516-371-6884
Practice Address - Fax:516-371-6083
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013174363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant