Healthcare Provider Details

I. General information

NPI: 1427078781
Provider Name (Legal Business Name): JOSE M DIAZ M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 10/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8016 2ND ST
DOWNEY CA
90241-3622
US

IV. Provider business mailing address

9302 CORD AVE
DOWNEY CA
90240-3028
US

V. Phone/Fax

Practice location:
  • Phone: 562-862-7744
  • Fax: 562-407-2082
Mailing address:
  • Phone: 562-688-4455
  • Fax: 323-588-0422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA76805
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA76805
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: