Provider Demographics
NPI:1730438367
Name:ASSED BASTOS, DIOGO (MD)
Entity type:Individual
Prefix:DR
First Name:DIOGO
Middle Name:
Last Name:ASSED BASTOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 E 90TH ST
Mailing Address - Street 2:APT 3G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-2606
Mailing Address - Country:US
Mailing Address - Phone:917-213-7624
Mailing Address - Fax:
Practice Address - Street 1:174 E 90TH ST
Practice Address - Street 2:APT 3G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-2606
Practice Address - Country:US
Practice Address - Phone:917-213-7624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program