MEDICARE: DR. SONIA DIAZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	208297	MA

General Provider Information

NPI Number	:	1396720264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SONIA DIAZ MD

Provider Business Mailing Address
First Line	:	56 LAUREL RD
Second Line	:
City	:	MILTON
State	:	MA
Zip	:	02186-1539
Country	:	US
Telephone Number	:	617-696-2191
Fax Number	:

Provider Business Practice Location Address
First Line	:	3297 WASHINGTON ST
Second Line	:
City	:	JAMAICA PLAIN
State	:	MA
Zip	:	02130-2655
Country	:	US
Telephone Number	:	617-983-6039
Fax Number	:	617-524-1716

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	01/30/2013

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