Healthcare Provider Details

I. General information

NPI: 1801880638
Provider Name (Legal Business Name): JULIO GABRIEL DIAZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

Provider Other Name: JULIO GABRIEL DIAZ-ORTERO MD

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 N MILPAS ST
SANTA BARBARA CA
93103-3137
US

IV. Provider business mailing address

510 N MILPAS ST
SANTA BARBARA CA
93103-3137
US

V. Phone/Fax

Practice location:
  • Phone: 805-962-8880
  • Fax: 805-957-1642
Mailing address:
  • Phone: 805-962-8880
  • Fax: 805-957-1642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberA36932
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: