Provider Demographics
NPI:1245677426
Name:DIAZ, LUIS DANIEL (MD)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:DANIEL
Last Name:DIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6 WELLNESS WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2156
Mailing Address - Country:US
Mailing Address - Phone:518-783-3110
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:6 WELLNESS WAY STE 106
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2156
Practice Address - Country:US
Practice Address - Phone:518-980-9040
Practice Address - Fax:518-980-9041
Is Sole Proprietor?:No
Enumeration Date:2013-05-29
Last Update Date:2024-03-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY303957207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine