Healthcare Provider Details

I. General information

NPI: 1184218364
Provider Name (Legal Business Name): LAURA MARIELIS HERNANDEZ-DIAZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2021
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13123 E 16TH AVE
AURORA CO
80045-7106
US

IV. Provider business mailing address

13123 E 16TH AVE # 290
AURORA CO
80045-7106
US

V. Phone/Fax

Practice location:
  • Phone: 720-777-2738
  • Fax:
Mailing address:
  • Phone: 720-777-2738
  • Fax: 720-777-7277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberDR.0078221
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: