Provider Demographics
NPI:1699799734
Name:DIAZ, JOHN PATRICK CACHO (RPT)
Entity type:Individual
Prefix:
First Name:JOHN PATRICK
Middle Name:CACHO
Last Name:DIAZ
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9125 KIRBY CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-1552
Mailing Address - Country:US
Mailing Address - Phone:858-208-6942
Mailing Address - Fax:
Practice Address - Street 1:259 CAMINO TABLERO
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92029-7444
Practice Address - Country:US
Practice Address - Phone:760-809-6739
Practice Address - Fax:760-747-5777
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT29902225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist