Healthcare Provider Details

I. General information

NPI: 1053354597
Provider Name (Legal Business Name): RODNEY C. DIAZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 01/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 STOCKTON BLVD SUITE 7200
SACRAMENTO CA
95817-2207
US

IV. Provider business mailing address

2521 STOCKTON BLVD SUITE 7200
SACRAMENTO CA
95817-2207
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-3744
  • Fax: 916-703-5011
Mailing address:
  • Phone: 916-734-3744
  • Fax: 916-703-5011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA074869
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number4301083300
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License NumberA074869
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number4301083300
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: