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General NPI Number Information
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NPI Number | 1578917936
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Entity Type | Individual
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Provider Name | JOSE LUIS DIEGO M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/21/2016
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 1317 OAKDALE RD STE 420
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City | MODESTO
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State | CA
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Zip | 95355-3364
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Country | US
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Telephone | 209-522-3362
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Fax |
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Provider Business Mailing Address
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Address Line | 1516 TRAILS WAY
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City | MODESTO
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State | CA
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Zip | 95357-0622
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Country | US
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Telephone | 209-581-3052
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036161333
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A185841
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License Number State | CA
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