Healthcare Provider Details

I. General information

NPI: 1710102272
Provider Name (Legal Business Name): DIAZ INTERNAL MEDICINE AND PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 11/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 N LITCHFIELD RD SUITE 130
GOODYEAR AZ
85395-7804
US

IV. Provider business mailing address

14175 W INDIAN SCHOOL RD SUITE B4 605
GOODYEAR AZ
85395-8369
US

V. Phone/Fax

Practice location:
  • Phone: 623-536-7600
  • Fax: 623-536-7828
Mailing address:
  • Phone: 623-536-7600
  • Fax: 623-536-7828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number31532
License Number StateAZ

VIII. Authorized Official

Name: VICENTE DIAZ-GONZALEZ
Title or Position: OWNER AND PHYSICIAN
Credential: M.D.
Phone: 623-536-7600