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General NPI Number Information
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NPI Number | 1154586535
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Entity Type | Individual
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Provider Name | ROBERT DIAZ
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Gender | Male
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Dates
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Enumeration Date | 07/24/2008
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Last Update Date | 07/24/2008
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Provider Practice Location Address
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Address Line | 644 NAPLES ST
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City | CHULA VISTA
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State | CA
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Zip | 91911-1636
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Country | US
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Telephone | 619-744-5362
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Fax |
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Provider Business Mailing Address
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Address Line | 323 CIRCULO CORONADO
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City | CHULA VISTA
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State | CA
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Zip | 91914-4444
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Country | US
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Telephone |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA16822
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License Number State | CA
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