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NPI Code Detail

MEDICARE: KEVIN DIAZ

MEDICARE: KEVIN DIAZ
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
1156FX1800XOptician4263MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1164822516
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEVIN DIAZ
Provider Business Mailing Address
First Line : 40 ENON ST
Second Line :
City : BEVERLY
State : MA
Zip : 01915-1168
Country : US
Telephone Number : 978-922-5996
Fax Number :
Provider Business Practice Location Address
First Line : 40 ENON ST
Second Line :
City : BEVERLY
State : MA
Zip : 01915-1168
Country : US
Telephone Number : 978-922-5996
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/03/2014
Last Update Date : 09/03/2014

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Directions to “ KEVIN DIAZ ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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