Provider Demographics
NPI:1871778308
Name:DIAZ, MARIA ISABEL (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:ISABEL
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1684 FOOTE AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-9385
Mailing Address - Country:US
Mailing Address - Phone:716-661-9730
Mailing Address - Fax:716-661-9732
Practice Address - Street 1:1684 FOOTE AVENUE EXT
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-9385
Practice Address - Country:US
Practice Address - Phone:716-661-9730
Practice Address - Fax:716-661-9732
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY246964208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02936767Medicaid