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General NPI Number Information
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NPI Number | 1144841172
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Entity Type | Individual
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Provider Name | KING NINO DIAZ
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Gender | Male
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Dates
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Enumeration Date | 04/30/2020
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Last Update Date | 06/08/2026
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Provider Practice Location Address
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Address Line | 100 W CALIFORNIA BLVD
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City | PASADENA
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State | CA
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Zip | 91105-3010
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Country | US
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Telephone | 855-522-7898
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 60259
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City | LOS ANGELES
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State | CA
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Zip | 90060-0259
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Country | US
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Telephone | 877-346-2211
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95034277
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95016752
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License Number State | CA
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