1255754438 NPI number — DAVID DIAZ O.D.

Table of content: DAVID DIAZ O.D. (NPI 1255754438)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255754438 NPI number — DAVID DIAZ O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIAZ
Provider First Name:
DAVID
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255754438
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14405 W. COLFAX AVE
Provider Second Line Business Mailing Address:
#310
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
80401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-522-7137
Provider Business Mailing Address Fax Number:
303-302-6906

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2156 E. WILLIAMS FIELD RD.
Provider Second Line Business Practice Location Address:
#104
Provider Business Practice Location Address City Name:
GILBERT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85296
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-814-2584
Provider Business Practice Location Address Fax Number:
480-963-9591
Provider Enumeration Date:
01/24/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1957 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)