Healthcare Provider Details

I. General information

NPI: 1134161144
Provider Name (Legal Business Name): GUILLERMO DIAZ JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 04/30/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2829 S GRAND AVE
LOS ANGELES CA
90007-3304
US

IV. Provider business mailing address

350 S FIGUEROA ST STE 990
LOS ANGELES CA
90071-1308
US

V. Phone/Fax

Practice location:
  • Phone: 213-699-7000
  • Fax:
Mailing address:
  • Phone: 213-288-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA86465
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: