Individual
DIANA MICHELLE VILA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
55 FRUIT ST, BLAKE 1500, BOSTON, MA 02114-2696
(617) 724-3874
Mailing address
55 FRUIT ST, BLAKE 15, BOSTON, MA 02114-2696
(617) 724-3874
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
282843
MA
207R00000X
Internal Medicine Physician
R7921
TX
208M00000X
Hospitalist Physician
282843
MA
208M00000X
Hospitalist Physician
R7921
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
402831801
—
TX
01
—
402831802
MEDICAID-CSHCN
TX
01
—
8LR236
BCBS
TX
Enumeration date
05/11/2016
Last updated
05/28/2020
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