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NPI Code Detail

MEDICARE: JAN MICHAEL VINCENT GALANG DIAZ

MEDICARE: JAN MICHAEL VINCENT GALANG DIAZ
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner816419NV
2363LF0000XFamily Nurse Practitioner816419NV

General Provider Information

NPI Number : 1023570090
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAN MICHAEL VINCENT GALANG DIAZ
Provider Business Mailing Address
First Line : 930 CARNEGIE ST UNIT 921
Second Line :
City : HENDERSON
State : NV
Zip : 89052-4512
Country : US
Telephone Number : 661-607-6014
Fax Number :
Provider Business Practice Location Address
First Line : 4270 S DECATUR BLVD STE B5
Second Line :
City : LAS VEGAS
State : NV
Zip : 89103-6802
Country : US
Telephone Number : 725-220-4200
Fax Number : 725-220-4199
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2019
Last Update Date : 06/09/2022

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Directions to “ JAN MICHAEL VINCENT GALANG DIAZ ” Practice Location

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