MEDICARE: DIANA P VACA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	208000000X	Pediatrics Physician	295001	NY

General Provider Information

NPI Number	:	1316321508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA P VACA MD

Provider Business Mailing Address
First Line	:	3032 CORLEAR AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-5141
Country	:	US
Telephone Number	:	718-548-4040
Fax Number	:	718-548-3939

Provider Business Practice Location Address
First Line	:	3032 CORLEAR AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-5141
Country	:	US
Telephone Number	:	718-548-4040
Fax Number	:	718-548-3939

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2015
Last Update Date	:	03/07/2023

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