Provider Demographics
NPI:1194506162
Name:DIAZ, DEANNA MARINA (DO)
Entity type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:MARINA
Last Name:DIAZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 W MASTER ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19122-4516
Mailing Address - Country:US
Mailing Address - Phone:215-917-6110
Mailing Address - Fax:
Practice Address - Street 1:110 PATERSON ST
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-2096
Practice Address - Country:US
Practice Address - Phone:215-917-6110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program