Healthcare Provider Details

I. General information

NPI: 1891808143
Provider Name (Legal Business Name): MISS GLORIA M DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 W 4TH ST SUITE 6
WILMINGTON DE
19805-3367
US

IV. Provider business mailing address

2500 W 4TH ST SUITE 6
WILMINGTON DE
19805-3367
US

V. Phone/Fax

Practice location:
  • Phone: 302-482-3388
  • Fax: 302-482-3389
Mailing address:
  • Phone: 302-482-3388
  • Fax: 302-482-3389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG0000346
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: