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General NPI Number Information
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NPI Number | 1700071529
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Entity Type | Organization
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Legal Business Name | REX GALAM DIAZ
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Dates
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Enumeration Date | 09/14/2007
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Last Update Date | 04/25/2011
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Provider Practice Location Address
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Address Line | 612 KINGSBOROUGH SQ SUITE 202
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City | CHESAPEAKE
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State | VA
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Zip | 23320
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Country | US
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Telephone | 757-673-8562
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Fax |
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Provider Business Mailing Address
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Address Line | 612 KINGSBOROUGH SQ STE 202
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City | CHESAPEAKE
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State | VA
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Zip | 23320-5054
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Country | US
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Telephone | 757-673-8562
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | REX GALAM DIAZ
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Credential | DPM
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Telephone | 757-673-8562
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 0103300814
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License Number State | VA
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