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General NPI Number Information
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NPI Number | 1215359781
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Entity Type | Individual
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Provider Name | ALEXANDER DIAZ LAC
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Gender | Male
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Dates
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Enumeration Date | 01/17/2014
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 1760 SW 3RD ST
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City | CORVALLIS
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State | OR
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Zip | 97333-1725
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Country | US
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Telephone | 541-380-1327
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Fax | 888-972-4948
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Provider Business Mailing Address
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Address Line | 1551 PROFESSIONAL LANE, SUITE 180
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City | LONGMONT
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State | CO
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Zip | 80501
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Country | US
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Telephone | 303-772-0598
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 190492
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 1932
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License Number State | CO
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