Individual
MARTHA SIERRA DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
25 PARK ST, NP1 SMILOW CANCER HOSPITAL/YNHH, NEW HAVEN, CT 06519-1110
(203) 200-4176
(203) 200-5075
Mailing address
25 PARK ST, NP1 SMILOW CANCER HOSPITAL/YNHH, NEW HAVEN, CT 06519-1110
(203) 200-4176
(203) 200-5075
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
000762
CT
363A00000X
Physician Assistant
5601005665
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1447261730
BCBSM
MI
Enumeration date
02/26/2010
Last updated
03/31/2015
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