Maritza I Diaz, DMD
Individual provider Active NPI Dentist · Manassas Park, VA
NPI 1861591968 · NPPES record last updated Jun 15, 2021
Key facts
- NPI
- 1861591968
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 0401411863 (VA)
- Practice address
- 9110 Railroad Dr Ste 201
Manassas Park, VA 20111-7041 - Phone
- (703) 365-0230
- NPI assigned
- Sep 22, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161212000452 | VA | Order and Referring Only - Dentist |
5092095968 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| T James Batistas DDS PLLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 0401411863 | VA | Yes |
Addresses
Primary practice location
9110 Railroad Dr Ste 201
Manassas Park, VA 20111-7041
Mailing address
9172 Laurel Highlands PL
Manassas, VA 20112-5857
Phone (787) 557-2704
Other providers in Manassas Park, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 15, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.