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NPI Code Detail

MEDICARE: ANTHONY BRYAN DIAZ

MEDICARE: ANTHONY BRYAN 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
1171M00000XCase Manager/Care Coordinator
2106S00000XBehavior Technician

General Provider Information

NPI Number : 1457994303
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANTHONY BRYAN DIAZ
Provider Business Mailing Address
First Line : 201 N BRAND BLVD OFC 233
Second Line :
City : GLENDALE
State : CA
Zip : 91203-3588
Country : US
Telephone Number : 818-722-1770
Fax Number : 855-568-2494
Provider Business Practice Location Address
First Line : 201 N BRAND BLVD OFC 233
Second Line :
City : GLENDALE
State : CA
Zip : 91203-3588
Country : US
Telephone Number : 818-722-1770
Fax Number : 855-568-2494
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2019
Last Update Date : 11/01/2022

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Directions to “ ANTHONY BRYAN DIAZ ” Practice Location

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