Healthcare Provider Details

I. General information

NPI: 1417996687
Provider Name (Legal Business Name): STEPHEN F DIAZ P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3941 J ST SUITE 270
SACRAMENTO CA
95819-3628
US

IV. Provider business mailing address

3941 J ST SUITE 270
SACRAMENTO CA
95819-3628
US

V. Phone/Fax

Practice location:
  • Phone: 916-733-6850
  • Fax: 916-733-6824
Mailing address:
  • Phone: 916-733-6850
  • Fax: 916-733-6824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA10027
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: