=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326906462
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VICTOR DIAZ JR.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2026
-----------------------------------------------------
Last Update Date | 01/15/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3645 SAN PABLO DAM RD
-----------------------------------------------------
City | EL SOBRANTE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94803-2729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-701-9496
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3645 SAN PABLO DAM RD
-----------------------------------------------------
City | EL SOBRANTE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94803-2729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------