Most Relevant Information
Provider Data
| NPI Number: | 1003290099 |
| Provider Name: | CARMEN DIAZ M.A. |
| Entity Type: | Individual |
| Taxonomy Code: | 171W00000X |
| Specialty: | Contractor |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/20/2015 |
| Last Updated: | 07/20/2015 |
Provider Practice Location
66-88 MYRTLE AVENUE
GLENDALE
NY
11385
Practice Location Phone/Fax
| Phone: | 7188500440 |
| Fax: |
Provider Mailing Location
6210 80TH RD
GLENDALE
NY
113856828
Provider Mailing Phone/Fax
| Phone: | 3479678486 |
| Fax: |