Healthcare Provider Details

I. General information

NPI: 1770346546
Provider Name (Legal Business Name): GABRIELA DIAZ RD CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 07/12/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14430 35TH AVE APT B54
FLUSHING NY
11354-3626
US

IV. Provider business mailing address

14430 35TH AVE APT B54
FLUSHING NY
11354-3626
US

V. Phone/Fax

Practice location:
  • Phone: 718-710-7269
  • Fax:
Mailing address:
  • Phone: 718-710-7269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1101X
TaxonomyGerontological Nutrition Registered Dietitian
License Number86098314
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86098314
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: