Healthcare Provider Details

I. General information

NPI: 1447678149
Provider Name (Legal Business Name): CARLOS MANUEL DIAZ MELEAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 OLIVEWOOD DR STE B
MERCED CA
95348-1256
US

IV. Provider business mailing address

OLIVEWOOD PEDIATRICS 1190 OLIVEWOOD DRIVE SUITE B
MERCED CA
95348
US

V. Phone/Fax

Practice location:
  • Phone: 559-353-5700
  • Fax: 559-353-5708
Mailing address:
  • Phone: 559-353-5700
  • Fax: 559-353-5708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA148789
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: