Provider Demographics
NPI:1215359781
Name:DIAZ, ALEXANDER (LAC)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:DIAZ
Suffix:
Gender:
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 PROFESSIONAL LANE, SUITE 180
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501
Mailing Address - Country:US
Mailing Address - Phone:303-772-0598
Mailing Address - Fax:
Practice Address - Street 1:1760 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-1725
Practice Address - Country:US
Practice Address - Phone:541-380-1327
Practice Address - Fax:888-972-4948
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-17
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR190492171100000X
CO1932171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist