Provider Demographics
NPI:1851701346
Name:DIAZ, ROSA I
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:
Last Name:DIAZ
Suffix:I
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 1:2964 PERRY AVE APT 5G
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-2122
Mailing Address - Country:US
Mailing Address - Phone:347-861-0138
Mailing Address - Fax:
Practice Address - Street 1:2250 HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-9402
Practice Address - Country:US
Practice Address - Phone:718-798-7801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program