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NPI Code Detail

MEDICARE: JOSEPH THOMAS DIAZ

MEDICARE: JOSEPH THOMAS 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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1205786019
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSEPH THOMAS DIAZ
Provider Business Mailing Address
First Line : 1632 SE KNAPP ST
Second Line :
City : PORTLAND
State : OR
Zip : 97202-6010
Country : US
Telephone Number : 516-203-2384
Fax Number :
Provider Business Practice Location Address
First Line : 1498 SE TECH CENTER PL STE 180
Second Line :
City : VANCOUVER
State : WA
Zip : 98683-5518
Country : US
Telephone Number : 360-619-2226
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2026
Last Update Date : 01/31/2026

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Directions to “ JOSEPH THOMAS DIAZ ” Practice Location

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