MEDICARE: RICHARD PASION DIAZ HM61304379

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
1	311ZA0620X	Adult Care Home Facility	755865	WA

General Provider Information

NPI Number	:	1427773878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD PASION DIAZ HM61304379

Provider Business Mailing Address
First Line	:	1501 EVANSTON CT NE
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98506-1002
Country	:	US
Telephone Number	:	360-357-6125
Fax Number	:	360-455-4618

Provider Business Practice Location Address
First Line	:	1501 EVANSTON CT NE
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98506-1002
Country	:	US
Telephone Number	:	360-357-6125
Fax Number	:	360-455-4618

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2022
Last Update Date	:	10/07/2022

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