MEDICARE: DR. JUAN CARLOS DIAZCADENA 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	207V00000X	Obstetrics & Gynecology Physician	26376	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Z105923	OTHER		MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	438649	OTHER	AZ	AHCCCS

General Provider Information

NPI Number	:	1730182544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUAN CARLOS DIAZCADENA MD

Provider Business Mailing Address
First Line	:	PO BOX 33269
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85067-3269
Country	:	US
Telephone Number	:	602-406-4786
Fax Number	:	916-636-4358

Provider Business Practice Location Address
First Line	:	500 W THOMAS RD
Second Line	:	STE 720 & STE 730
City	:	PHOENIX
State	:	AZ
Zip	:	85013-4409
Country	:	US
Telephone Number	:	602-406-3715
Fax Number	:	602-406-4011

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	12/10/2024

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