Provider Demographics
NPI:1871751172
Name:DIAZ, ANGEL ALBERTO (MD)
Entity type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:ALBERTO
Last Name:DIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805B SOUNDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-3900
Mailing Address - Country:US
Mailing Address - Phone:718-483-9918
Mailing Address - Fax:718-483-9919
Practice Address - Street 1:805B SOUNDVIEW AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-3900
Practice Address - Country:US
Practice Address - Phone:718-483-9918
Practice Address - Fax:718-483-9919
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-23
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY263664207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03439452Medicaid