Healthcare Provider Details

I. General information

NPI: 1003258922
Provider Name (Legal Business Name): IDABELLE DIAZ-GARCIA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2013
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5065 FOREST DR STE 101
NEW ALBANY OH
43054-8778
US

IV. Provider business mailing address

5065 FOREST DR STE 101
NEW ALBANY OH
43054-8778
US

V. Phone/Fax

Practice location:
  • Phone: 614-618-0514
  • Fax: 614-333-8339
Mailing address:
  • Phone: 614-618-0514
  • Fax: 614-333-8339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5001008RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: