MEDICARE: VICENTE ISAI 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
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1285589275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICENTE ISAI DIAZ

Provider Business Mailing Address
First Line	:	27923 HAVANA AVE
Second Line	:
City	:	HAYWARD
State	:	CA
Zip	:	94544-5009
Country	:	US
Telephone Number	:	510-941-6410
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 B ST
Second Line	:
City	:	HAYWARD
State	:	CA
Zip	:	94541-3020
Country	:	US
Telephone Number	:	510-688-8166
Fax Number	:

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

Provider Enumeration Date	:	03/04/2026
Last Update Date	:	03/04/2026

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Directions to “ VICENTE ISAI DIAZ ” Practice Location

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