Healthcare Provider Details

I. General information

NPI: 1285011908
Provider Name (Legal Business Name): OLGA DIAZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2015
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STATE ST IPT C3F107
LOS ANGELES CA
90033-1029
US

IV. Provider business mailing address

1200 N STATE ST IPT C3F107
LOS ANGELES CA
90033-1029
US

V. Phone/Fax

Practice location:
  • Phone: 323-409-8848
  • Fax: 323-441-7219
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA135754
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: