MEDICARE: HECTOR DIAZ

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	172A00000X	Driver		NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407225980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HECTOR DIAZ

Provider Business Mailing Address
First Line	:	244 W 231ST ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-5357
Country	:	US
Telephone Number	:	718-543-7777
Fax Number	:	718-543-7780

Provider Business Practice Location Address
First Line	:	244 W 231ST ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-5357
Country	:	US
Telephone Number	:	718-543-7777
Fax Number	:	718-543-7780

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

Provider Enumeration Date	:	09/15/2015
Last Update Date	:	06/20/2017

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Directions to “ HECTOR DIAZ ” Practice Location

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