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NPI Code Detail

MEDICARE: DR. GUILLERMO DIAZ JR. M.D.

MEDICARE: DR. GUILLERMO DIAZ JR. M.D.
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
1208000000XPediatrics PhysicianA86465CA

General Provider Information

NPI Number : 1134161144
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GUILLERMO DIAZ JR. M.D.
Provider Business Mailing Address
First Line : 350 S FIGUEROA ST STE 990
Second Line :
City : LOS ANGELES
State : CA
Zip : 90071-1308
Country : US
Telephone Number : 213-288-9000
Fax Number :
Provider Business Practice Location Address
First Line : 2829 S GRAND AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90007-3304
Country : US
Telephone Number : 213-699-7000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2006
Last Update Date : 04/30/2021

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