=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942256482
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAINIER J DIAZ M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8050 E LAKESIDE PKWY
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85730-1254
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-584-5820
-----------------------------------------------------
Fax | 520-514-1514
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7829 E WHILEAWAY PL
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85750-7409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax | 520-620-1598
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 26841
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------