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General NPI Number Information
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NPI Number | 1710102272
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Entity Type | Organization
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Legal Business Name | DIAZ INTERNAL MEDICINE AND PEDIATRICS
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 11/13/2008
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Provider Practice Location Address
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Address Line | 3050 N LITCHFIELD RD SUITE 130
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City | GOODYEAR
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State | AZ
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Zip | 85395-7804
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Country | US
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Telephone | 623-536-7600
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Fax | 623-536-7828
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Provider Business Mailing Address
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Address Line | 14175 W INDIAN SCHOOL RD SUITE B4 605
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City | GOODYEAR
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State | AZ
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Zip | 85395-8369
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Country | US
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Telephone | 623-536-7600
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Fax | 623-536-7828
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Authorized Official
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Title or Position | OWNER AND PHYSICIAN
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Name | VICENTE DIAZ-GONZALEZ
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Credential | M.D.
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Telephone | 623-536-7600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 31532
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License Number State | AZ
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