Individual provider Active NPI

Diosita Watin Lariosa, M.D.,P.C.

  • Pediatric Adolescent Medicine Physician
  • Albany, GA
National Provider Identifier
1336285691
Registry record updated Apr 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
License
21325 Issued in GA
Practice address
513 W 2ND Ave
Albany, GA 31701-2204
Phone
(229) 432-7444
Fax
(229) 432-7445
NPI assigned
Jan 30, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 17, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine Physician 2080A0000X 21325 GA Primary

Addresses

Primary practice location

513 W 2ND Ave
Albany, GA 31701-2204

Mailing address

513 W 2ND Ave
Albany, GA 31701-2204
Phone (229) 432-7444

Other identifiers 3

IdentifierTypeStateIssuer
000236959AOtherGAPEACHSTATE MEDICAID
336022OtherGAWELLCARE MEDICAID
000236959AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
21325GAMDPediatric Adolescent Medicine Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208390400000",
    "number": "1336285691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "513 W 2ND AVE",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317012204",
            "telephone_number": "229-432-7444",
            "fax_number": "229-432-7445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "513 W 2ND AVE",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317012204",
            "telephone_number": "229-432-7444",
            "fax_number": "229-432-7445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARIOSA",
        "first_name": "DIOSITA",
        "middle_name": "WATIN",
        "credential": "M.D.,P.C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-30",
        "last_updated": "2008-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "GA",
            "license": "21325",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PEACHSTATE MEDICAID",
            "identifier": "000236959A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE MEDICAID",
            "identifier": "336022",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000236959A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albany, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.