Basic Information
| Provider Information | |||||||||
| NPI: | 1639597339 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIAZ | ||||||||
| FirstName: | SOFIA | ||||||||
| MiddleName: | IVANA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 CEDAR ST # 3 | ||||||||
| Address2: | YUSM DEPT OF ANESTHESIOLOGY | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065103206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037852802 | ||||||||
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| Practice Location | |||||||||
| Address1: | 333 CEDAR ST # 3 | ||||||||
| Address2: | YUSM DEPT OF ANESTHESIOLOGY | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065103206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037852802 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2014 | ||||||||
| LastUpdateDate: | 04/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207L00000X | 64885 | CT | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.