Provider Demographics
NPI:1154203560
Name:DIAZ, ANGELO LUIZ
Entity type:Individual
Prefix:
First Name:ANGELO
Middle Name:LUIZ
Last Name:DIAZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 S MARIPOSA WAY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80223-2746
Mailing Address - Country:US
Mailing Address - Phone:720-270-7597
Mailing Address - Fax:
Practice Address - Street 1:718 S MARIPOSA WAY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80223-2746
Practice Address - Country:US
Practice Address - Phone:720-270-7597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist