Healthcare Provider Details

I. General information

NPI: 1417098369
Provider Name (Legal Business Name): MICHELLE ANN DIAZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1618 E PINE ST
SILVER CITY NM
88061-7155
US

IV. Provider business mailing address

1618 E PINE ST CASSIE HEALTH CENTER FOR WOMEN
SILVER CITY NM
88061-7155
US

V. Phone/Fax

Practice location:
  • Phone: 575-388-1561
  • Fax: 575-388-9952
Mailing address:
  • Phone: 575-388-1561
  • Fax: 575-388-9952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD2009-0200
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: