Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0102X | Surgical Critical Care | 284091 | NY |
NPI | 1013323666 |
---|---|
Provider Name | Dr. Herminio Diaz |
First Address | Hawthorne, NY 10532-2140 |
Second Address | Poughkeepsie, NY 12601-1154 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2014 |
Last Update Date | 01/07/2021 |