Provider Demographics
NPI:1679633846
Name:MONERO, MARIA DIAZ
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:DIAZ
Last Name:MONERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4036 JUNCTION BLVD
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-2122
Mailing Address - Country:US
Mailing Address - Phone:718-899-4302
Mailing Address - Fax:
Practice Address - Street 1:4036 JUNCTION BLVD
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-2122
Practice Address - Country:US
Practice Address - Phone:718-899-4302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195415173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01621392Medicaid
NY162391Medicare ID - Type Unspecified