Provider Demographics
NPI:1063977015
Name:DIAZ, SEBASTIAN JOSE (MD)
Entity type:Individual
Prefix:DR
First Name:SEBASTIAN
Middle Name:JOSE
Last Name:DIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SEBASTIAN
Other - Middle Name:JOSE
Other - Last Name:DIAZ RIOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:40 CANNON ST APT 2K
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-3283
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:45 READE PL
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-3947
Practice Address - Country:US
Practice Address - Phone:845-454-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-04
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program