Healthcare Provider Details

I. General information

NPI: 1275938482
Provider Name (Legal Business Name): EMMANUEL DIAZ GUERRERO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2014
Last Update Date: 04/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 E 180TH ST
BRONX NY
10457-3601
US

IV. Provider business mailing address

705 E 180TH ST
BRONX NY
10457-3601
US

V. Phone/Fax

Practice location:
  • Phone: 718-220-0507
  • Fax: 718-220-8419
Mailing address:
  • Phone: 718-220-0507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number281405
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: