Healthcare Provider Details

I. General information

NPI: 1033053095
Provider Name (Legal Business Name): DULCE MARISOL DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 HARRISON ST
SAN FRANCISCO CA
94107-1235
US

IV. Provider business mailing address

760 HARRISON ST
SAN FRANCISCO CA
94107-1235
US

V. Phone/Fax

Practice location:
  • Phone: 628-754-8738
  • Fax: 628-754-8691
Mailing address:
  • Phone: 628-754-8738
  • Fax: 628-754-8691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number21340-20
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberCPT-02343582
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: