MEDICARE: ALEX DIAZ D.O.

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	207RP1001X	Pulmonary Disease Physician	20A18649	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659759363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEX DIAZ D.O.

Provider Business Mailing Address
First Line	:	5401 NORRIS CANYON RD STE 308
Second Line	:
City	:	SAN RAMON
State	:	CA
Zip	:	94583-5408
Country	:	US
Telephone Number	:	925-866-8822
Fax Number	:

Provider Business Practice Location Address
First Line	:	5401 NORRIS CANYON RD STE 306
Second Line	:
City	:	SAN RAMON
State	:	CA
Zip	:	94583-5408
Country	:	US
Telephone Number	:	925-866-8822
Fax Number	:

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

Provider Enumeration Date	:	05/13/2015
Last Update Date	:	09/08/2021

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