Healthcare Provider Details

I. General information

NPI: 1740413749
Provider Name (Legal Business Name): DR. ROBERTO ORLANDO DIAZ DEL CARPIO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2009
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 E 4TH ST
LONG BEACH CA
90802-1831
US

IV. Provider business mailing address

1220 E 4TH ST
LONG BEACH CA
90802-1831
US

V. Phone/Fax

Practice location:
  • Phone: 888-530-4415
  • Fax: 855-712-7837
Mailing address:
  • Phone: 888-530-4415
  • Fax: 855-712-7837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number272608
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number272608
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: