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General NPI Number Information
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NPI Number | 1629259825
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Entity Type | Organization
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Legal Business Name | SPECIALTY MEDICAL GROUP CENTRAL CALIFORNIA - DEPT OF PLASTIC SURGERY
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Dates
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Enumeration Date | 11/16/2007
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Last Update Date | 11/16/2007
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Provider Practice Location Address
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Address Line | 9300 VALLEY CHILDRENS PL GE07
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City | MADERA
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State | CA
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Zip | 93636-8761
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Country | US
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Telephone | 559-353-6277
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Fax | 559-353-5424
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Provider Business Mailing Address
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Address Line | 9300 VALLEY CHILDRENS PL
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City | MADERA
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State | CA
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Zip | 93636-8761
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Country | US
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Telephone | 559-353-6277
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Fax | 559-353-5424
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Authorized Official
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Title or Position | PRESIDENT AND MEDICAL DIRECTOR
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Name | RALPH P. DIAZ
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Credential | M.D.
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Telephone | 559-353-5016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State | CA
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