Healthcare Provider Details

I. General information

NPI: 1104833888
Provider Name (Legal Business Name): ANTONIO DIAZ GOMEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE # M1094 BOX 0111
SAN FRANCISCO CA
94143-2204
US

IV. Provider business mailing address

3514 26TH ST UNIT 2
SAN FRANCISCO CA
94110-4414
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-5896
  • Fax: 415-476-5712
Mailing address:
  • Phone: 916-548-9991
  • Fax: 415-476-5712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA86536
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA86536
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA86536
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: