Healthcare Provider Details

I. General information

NPI: 1588829675
Provider Name (Legal Business Name): RICARDO L VALLE DIAZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2008
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 DOCTORS DR STE G
KINSTON NC
28501-1584
US

IV. Provider business mailing address

PO BOX 2475
NATCHITOCHES LA
71457-2475
US

V. Phone/Fax

Practice location:
  • Phone: 252-522-4446
  • Fax: 252-522-4484
Mailing address:
  • Phone: 318-214-4200
  • Fax: 318-214-4633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2014-01700
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: