Healthcare Provider Details

I. General information

NPI: 1639764368
Provider Name (Legal Business Name): JANET DIAZ AGPC NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 4TH ST FL 1
SAN FRANCISCO CA
94143-2350
US

IV. Provider business mailing address

1510 E HERNDON AVE STE 310
FRESNO CA
93720-3393
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-7175
  • Fax: 415-476-7370
Mailing address:
  • Phone: 559-326-1222
  • Fax: 559-421-7004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11011970
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95018207
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN11011970
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: