Healthcare Provider Details

I. General information

NPI: 1164909271
Provider Name (Legal Business Name): CHRISTOPHER JORDAN DIAZ PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2018
Last Update Date: 07/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PASTEUR DR
STANFORD CA
94305-2200
US

IV. Provider business mailing address

91-1028 PANAPANAPUHI ST
EWA BEACH HI
96706-3575
US

V. Phone/Fax

Practice location:
  • Phone: 650-724-3449
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60753130
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH4217
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License Number77779
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: