Healthcare Provider Details

I. General information

NPI: 1053222471
Provider Name (Legal Business Name): LUZ EVITA DIAZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 STEELE RD
NEW WINDSOR NY
12553-6137
US

IV. Provider business mailing address

44 STEELE RD
NEW WINDSOR NY
12553-6137
US

V. Phone/Fax

Practice location:
  • Phone: 845-500-2904
  • Fax:
Mailing address:
  • Phone: 845-500-2904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number906863
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: