Provider Demographics
NPI:1760680938
Name:DIAZ VALENTIN, SARA I (MD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:I
Last Name:DIAZ VALENTIN
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 1:1100 REID PKWY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-962-8551
Mailing Address - Fax:765-962-2591
Practice Address - Street 1:1050 REID PKWY STE 325
Practice Address - Street 2:UROLOGICAL CARE
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1161
Practice Address - Country:US
Practice Address - Phone:765-962-8551
Practice Address - Fax:765-962-2591
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01062306A207V00000X, 207VF0040X
KY43070207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000001005930OtherANTHEM
IN200961220Medicaid
OH0164408Medicaid
IN200961220Medicaid
IN1487680518OtherGROUP NPI #
IN000000762095OtherANTHEM PIN
KY50026252OtherPASSPORT SPECIALITY FOUNDATION
IN200961220Medicaid
KY0722560Medicare PIN
KY000000637271OtherANTHEM PSC
KY3747399000OtherPASSPORT ADVANTAGE NUMBER - PSC
KY50026249OtherPASSPORT PCP - FOUNDATION
KY3745190000OtherPASSPORT ADVANTAGE SPECIALTY - FOUNDATION
INM400067750Medicare PIN