Healthcare Provider Details

I. General information

NPI: 1043645096
Provider Name (Legal Business Name): MONICA D DIAZ PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2013
Last Update Date: 09/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 TRAMWAY BLVD SE
ALBUQUERQUE NM
87123-3934
US

IV. Provider business mailing address

200 TRAMWAY BLVD SE
ALBUQUERQUE NM
87123-3934
US

V. Phone/Fax

Practice location:
  • Phone: 505-297-9751
  • Fax:
Mailing address:
  • Phone: 505-297-9751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00008025
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: