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NPI Code Detail

MEDICARE: JENNA NATALIA DIAZ M.D.

MEDICARE: JENNA NATALIA DIAZ M.D.
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
1208000000XPediatrics Physician2019017047MO
2390200000XStudent in an Organized Health Care Education/Training Program
32080P0206XPediatric Gastroenterology Physician22162NV

General Provider Information

NPI Number : 1730534843
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNA NATALIA DIAZ M.D.
Provider Business Mailing Address
First Line : 3196 S MARYLAND PKWY STE 309
Second Line :
City : LAS VEGAS
State : NV
Zip : 89109-2314
Country : US
Telephone Number : 702-791-0477
Fax Number : 702-791-6831
Provider Business Practice Location Address
First Line : 3196 S MARYLAND PKWY STE 309
Second Line :
City : LAS VEGAS
State : NV
Zip : 89109-2314
Country : US
Telephone Number : 702-791-0477
Fax Number : 702-791-6831
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2016
Last Update Date : 08/03/2025

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