Healthcare Provider Details

I. General information

NPI: 1508880097
Provider Name (Legal Business Name): ROSANNE DIAZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1736 HAMILTON ST
ALLENTOWN PA
18104-5656
US

IV. Provider business mailing address

801 OSTRUM ST
BETHLEHEM PA
18015-1000
US

V. Phone/Fax

Practice location:
  • Phone: 908-788-1710
  • Fax: 484-503-8281
Mailing address:
  • Phone: 484-503-8281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00134600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: