Provider Demographics
NPI:1427773878
Name:DIAZ, RICHARD PASION (HM61304379)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:PASION
Last Name:DIAZ
Suffix:
Gender:M
Credentials:HM61304379
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 EVANSTON CT NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-1002
Mailing Address - Country:US
Mailing Address - Phone:360-357-6125
Mailing Address - Fax:360-455-4618
Practice Address - Street 1:1501 EVANSTON CT NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-1002
Practice Address - Country:US
Practice Address - Phone:360-357-6125
Practice Address - Fax:360-455-4618
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA755865311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home