Healthcare Provider Details

I. General information

NPI: 1801822234
Provider Name (Legal Business Name): CAROLINA DIAZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLINA DIAZ PA-C

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E ST SW
WASHINGTON DC
20024-3242
US

IV. Provider business mailing address

401 E ST SW
WASHINGTON DC
20024-3242
US

V. Phone/Fax

Practice location:
  • Phone: 202-698-9010
  • Fax: 202-698-9103
Mailing address:
  • Phone: 202-698-9010
  • Fax: 202-698-9103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA030951
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: