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General NPI Number Information
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NPI Number | 1013223718
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Entity Type | Individual
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Provider Name | MR. ROSALIO L DIAZ
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Gender | Male
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Dates
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Enumeration Date | 08/19/2010
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Last Update Date | 08/19/2010
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Provider Practice Location Address
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Address Line | 644 NORTH 2865 EAST
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City | ROBERTS
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State | ID
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Zip | 83444-0108
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Country | US
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Telephone | 208-228-2435
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 108
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City | ROBERTS
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State | ID
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Zip | 83444-0108
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Country | US
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Telephone | 208-228-2435
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number | XA151417I
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License Number State | ID
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