Healthcare Provider Details

I. General information

NPI: 1831482629
Provider Name (Legal Business Name): AMILCAR DIAZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 07/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DRIVE SOUTH, UCI HEALTH DEPARTMENT OF RADIOLOGIC SCIENCE, SUITE 201
ORANGE CA
92868
US

IV. Provider business mailing address

26035 MOULTON PKWY # O229
LAGUNA HILLS CA
92653-6247
US

V. Phone/Fax

Practice location:
  • Phone: 714-509-2526
  • Fax:
Mailing address:
  • Phone: 858-335-5453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberA155426
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: