Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1982914099 |
---|---|
Provider Name | Richard Diaz |
First Address | New York, NY 10010-5011 |
Second Address | New York, NY 10010-5011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2010 |
Last Update Date | 08/10/2010 |