MEDICARE: THIERRY DIEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor	20161209961	NV

General Provider Information

NPI Number	:	1073067450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THIERRY DIEZ

Provider Business Mailing Address
First Line	:	6032 TERSKY CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-3443
Country	:	US
Telephone Number	:	702-601-9381
Fax Number	:	702-287-2832

Provider Business Practice Location Address
First Line	:	6032 TERSKY CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-3443
Country	:	US
Telephone Number	:	702-601-9381
Fax Number	:	702-287-2832

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2016
Last Update Date	:	08/15/2016

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Directions to “ THIERRY DIEZ ” Practice Location

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