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Individual
IAN DIAZ
Active
Individual
IAN DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301076711
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0Q26258
GROUP - GENL PRACTITIONER
MI
01
—
ID076711
LICENSE
MI
Enumeration date
07/20/2006
Last updated
12/05/2019
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