Healthcare Provider Details

I. General information

NPI: 1285485151
Provider Name (Legal Business Name): DIANA DY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 10/05/2025
Certification Date: 10/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY OF NEW MEXICO MSC10 5610
ALBUQUERQUE NM
87131
US

IV. Provider business mailing address

1 UNIVERSITY OF NEW MEXICO MSC10 5610
ALBUQUERQUE NM
87131
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-4161
  • Fax: 505-272-2776
Mailing address:
  • Phone: 505-272-4161
  • Fax: 505-272-2776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRS2024-0244
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: