Provider Demographics
NPI:1427078781
Name:DIAZ, JOSE M (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:M
Last Name:DIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9302 CORD AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240-3028
Mailing Address - Country:US
Mailing Address - Phone:562-688-4455
Mailing Address - Fax:323-588-0422
Practice Address - Street 1:8016 2ND ST
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-3622
Practice Address - Country:US
Practice Address - Phone:562-862-7744
Practice Address - Fax:562-407-2082
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA76805208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH99733Medicare UPIN