MEDICARE: MR. ANDREW DIAZ RRT

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	227900000X	Registered Respiratory Therapist	23758	CA

General Provider Information

NPI Number	:	1942627609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANDREW DIAZ RRT

Provider Business Mailing Address
First Line	:	38 ORLANDO CT
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91911-3405
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	38 ORLANDO CT
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91911-3405
Country	:	US
Telephone Number	:	619-942-2113
Fax Number	:

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

Provider Enumeration Date	:	03/19/2014
Last Update Date	:	03/19/2014

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