Healthcare Provider Details

I. General information

NPI: 1316652142
Provider Name (Legal Business Name): GABRIELA DIAZ LAZCANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVE # 7M
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

3299 26TH ST APT 2
SAN FRANCISCO CA
94110-4686
US

V. Phone/Fax

Practice location:
  • Phone: 628-206-8426
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: