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NPI Code Detail

MEDICARE: ALEXANDER DIAZ LAC

MEDICARE: ALEXANDER DIAZ LAC
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
1171100000XAcupuncturist190492OR
2171100000XAcupuncturist1932CO

General Provider Information

NPI Number : 1215359781
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXANDER DIAZ LAC
Provider Business Mailing Address
First Line : 1551 PROFESSIONAL LANE, SUITE 180
Second Line :
City : LONGMONT
State : CO
Zip : 80501
Country : US
Telephone Number : 303-772-0598
Fax Number :
Provider Business Practice Location Address
First Line : 1760 SW 3RD ST
Second Line :
City : CORVALLIS
State : OR
Zip : 97333-1725
Country : US
Telephone Number : 541-380-1327
Fax Number : 888-972-4948
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2014
Last Update Date : 04/30/2025

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Directions to “ ALEXANDER DIAZ LAC” Practice Location

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