Healthcare Provider Details

I. General information

NPI: 1972675775
Provider Name (Legal Business Name): MARIA JOSEFINA DIAZ M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4692 BROWNSBORO RD
WINSTON SALEM NC
27106-3410
US

IV. Provider business mailing address

4692 BROWNSBORO RD
WINSTON SALEM NC
27106-3410
US

V. Phone/Fax

Practice location:
  • Phone: 336-251-1114
  • Fax: 336-251-1117
Mailing address:
  • Phone: 336-251-1114
  • Fax: 336-251-1117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number16370
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number201200927
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number201200927
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: