MEDICARE: STEPHANIE LYNN NEWHART DIAZ M.S.

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	170300000X	Genetic Counselor (M.S.)

General Provider Information

NPI Number	:	1447325394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE LYNN NEWHART DIAZ M.S.

Provider Business Mailing Address
First Line	:	275 W MACARTHUR BLVD
Second Line	:	GENETICS DEPT
City	:	OAKLAND
State	:	CA
Zip	:	94611-5641
Country	:	US
Telephone Number	:	510-752-6302
Fax Number	:	510-752-6754

Provider Business Practice Location Address
First Line	:	3505 BROADWAY
Second Line	:	GENETICS DEPT - 10TH FLOOR
City	:	OAKLAND
State	:	CA
Zip	:	94611-5714
Country	:	US
Telephone Number	:	510-752-6302
Fax Number	:	510-752-6754

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

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	12/30/2021

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