Basic Information
| Provider Information | |||||||||
| NPI: | 1134476534 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIAZ | ||||||||
| FirstName: | DAHIANA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 853 E 218TH ST | ||||||||
| Address2: | 1ST FLOOR | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104675805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6464214851 | ||||||||
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| Practice Location | |||||||||
| Address1: | 535 8TH AVE | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100184305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127879700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2012 | ||||||||
| LastUpdateDate: | 08/06/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | 16893 | NY | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.