Provider Demographics
NPI:1861016495
Name:CEBRIAN CHAUSTRE, DIEGO JAVIER (MD)
Entity Type:Individual
Prefix:
First Name:DIEGO
Middle Name:JAVIER
Last Name:CEBRIAN CHAUSTRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 W KINGSBRIDGE ROAD
Mailing Address - Street 2:SUITE 7A-11
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468
Mailing Address - Country:US
Mailing Address - Phone:718-584-9000
Mailing Address - Fax:718-741-4233
Practice Address - Street 1:130 W KINGSBRIDGE ROAD
Practice Address - Street 2:SUITE 7A-11
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468
Practice Address - Country:US
Practice Address - Phone:718-584-9000
Practice Address - Fax:718-741-4233
Is Sole Proprietor?:No
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program