Healthcare Provider Details

I. General information

NPI: 1275333015
Provider Name (Legal Business Name): MS. MILDRED DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2025
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3708 91ST ST STE 3A
JACKSON HEIGHTS NY
11372-7962
US

IV. Provider business mailing address

212 W 129TH ST APT 11B
NEW YORK NY
10027-1924
US

V. Phone/Fax

Practice location:
  • Phone: 718-779-2263
  • Fax: 718-779-2225
Mailing address:
  • Phone: 347-326-2666
  • Fax: 347-326-2666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: