MEDICARE: GUSTAVO A. DIAZ MD

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	207P00000X	Emergency Medicine Physician	C54872	CA
2	207P00000X	Emergency Medicine Physician	53006	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000006706	OTHER	MA	BMC
2	04-3329195	OTHER	MA	NORTH AMERICAN PREFERRED
3	04-3329195	OTHER	MA	GREAT-WEST
4	102531	OTHER	MA	CIGNA
5	2359897	OTHER	MA	AETNA
6	04-3329195	OTHER	MA	PHCS
7	04-3329195	OTHER	MA	UNICARE/GIC
8	04-3329195	OTHER	MA	NORTHEAST HEALTHCARE ALLI
9	04-3329195	OTHER	MA	NORTHEAST HEALTH DIRECT
10	04-3329195	OTHER	MA	PLAN VISTA
11	053006	OTHER	MA	TUFTS
12	24922	OTHER	MA	HEALTH NEW ENGLAND
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
14	438822	OTHER	MA	HARVARD PILGRIM
15	632919	OTHER	MA	CONNECTICARE
16	J08576	OTHER	MA	BCBS MA
17	04-3329195	OTHER	MA	CONSOLIDATED

General Provider Information

NPI Number	:	1538122635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUSTAVO A. DIAZ MD

Provider Business Mailing Address
First Line	:	100 WILSON RD STE 100
Second Line	:
City	:	MONTEREY
State	:	CA
Zip	:	93940-7885
Country	:	US
Telephone Number	:	831-649-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	830 JEFFERSON AVE
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94063-1804
Country	:	US
Telephone Number	:	650-381-0616
Fax Number	:

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

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	03/16/2026

Similar Medicare Providers

1366744492 — JAMES WILLIS SIMMONS II NP
Practice Location Address:

830 JEFFERSON AVE
REDWOOD CITY, CA
94063-1804

Practice Phone: 650-380-0616
Practice Fax:

1811381825 — SANDAL HUSSAIN MD
Practice Location Address:

830 JEFFERSON AVE STE M
REDWOOD CITY, CA
94063-1804

Practice Phone: 650-861-0616
Practice Fax: 650-381-0617

1831046697 — LISA D. WELSH LMSW, LAC
Practice Location Address:

1804 ELMDALE AVE
JUNCTION CITY, KS
66441-1972

Practice Phone: 785-307-3126
Practice Fax:

1477406965 — TOTAL WOUND CARE, LLC
Practice Location Address:

1900 NW EXPRESSWAY STE 800
OKLAHOMA CITY, OK
73118-1804

Practice Phone: 405-246-0811
Practice Fax:

1073563284 — SHERRI BOSESKI A.P.N.-C
Practice Location Address:

196 JEWETT AVE
JERSEY CITY, NJ
07304-1804

Practice Phone: 201-536-9000
Practice Fax: 201-536-9047

1134170673 — NANCY REYES A.P.N.-C
Practice Location Address:

196 JEWETT AVE
JERSEY CITY, NJ
07304-1804

Practice Phone: 201-536-9000
Practice Fax: 201-536-9047

Directions to “ GUSTAVO A. DIAZ MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.