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General NPI Number Information
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NPI Number | 1851636294
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Entity Type | Individual
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Provider Name | WADDY OSVALDO GONZALEZ DIAZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/11/2012
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Last Update Date | 08/26/2019
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Provider Practice Location Address
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Address Line | 2385 E PRATER WAY STE 302
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City | SPARKS
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State | NV
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Zip | 89434-9638
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Country | US
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Telephone | 775-356-4514
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Fax | 775-356-4991
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Provider Business Mailing Address
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Address Line | 2345 E PRATER WAY STE 207
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City | SPARKS
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State | NV
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Zip | 89434-9634
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Country | US
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Telephone | 775-356-4514
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Fax | 775-356-4991
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 19199
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License Number State | NV
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