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General NPI Number Information
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NPI Number | 1376251785
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Entity Type | Individual
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Provider Name | JOSE GUADALUPE DIAZ-PEREZ
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Gender | Male
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Dates
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Enumeration Date | 11/14/2022
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Last Update Date | 05/15/2025
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Provider Practice Location Address
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Address Line | 421 CHAPANOKE RD STE 116
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City | RALEIGH
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State | NC
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Zip | 27603-3690
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Country | US
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Telephone | 919-679-9669
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Fax |
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Provider Business Mailing Address
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Address Line | 75 MACINTOSH LN
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City | HENDERSONVILLE
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State | NC
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Zip | 28792-5697
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Country | US
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Telephone | 828-708-3215
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0010-15016
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License Number State | NC
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