Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 036126434 | IL |
NPI | 1003987967 |
---|---|
Provider Name | Dr. Geraldine C. Diaz |
First Address | Brooklyn, NY 11203-2012 |
Second Address | Brooklyn, NY 11203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 10/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Z120519 | MEDICARE (01) | AZ |