MEDICARE: OLGA YASHIRA 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
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207P00000X	Emergency Medicine Physician	A156210	CA

General Provider Information

NPI Number	:	1598128217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLGA YASHIRA DIAZ

Provider Business Mailing Address
First Line	:	2004 BURROUGHS ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-6619
Country	:	US
Telephone Number	:	619-787-2699
Fax Number	:

Provider Business Practice Location Address
First Line	:	2004 BURROUGHS ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-6619
Country	:	US
Telephone Number	:	619-787-2699
Fax Number	:

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

Provider Enumeration Date	:	03/30/2016
Last Update Date	:	11/29/2021

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