=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295815090
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN FRANCISCO DIAZ M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2006
-----------------------------------------------------
Last Update Date | 10/28/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9201 W SUNSET BLVD SUITE 805
-----------------------------------------------------
City | WEST HOLLYWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90069-3701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-770-9949
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9201 W SUNSET BLVD SUITE 805
-----------------------------------------------------
City | WEST HOLLYWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90069-3701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-770-9949
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208200000X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery Physician
-----------------------------------------------------
License Number | A91692
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------