Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 26NJ00505300 | NJ |
N | 363LG0600X | Nurse Practitioner - Gerontology | 26NJ00505300 | NJ |
NPI | 1033526413 |
---|---|
Provider Name | Diego Loaiza |
First Address | Nutley, NJ 07110-1215 |
Second Address | Teaneck, NJ 07666-4513 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2014 |
Last Update Date | 21/01/2020 |