# GONZALO A DIAZ

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** GONZALO A DIAZ
- **Other names:** Los Alamos
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1366089237
- **Legal business name:** GONZALO A DIAZ
- **Authorized official:** GONZALO A DIAZ MD (OWNER)
- **Authorized official phone:** (915) 779-7378

## Contact information

- **Practice address:** 3917 WEST RD, LOS ALAMOS, NM 87544-2275
- **Practice address phone:** (915) 779-7378
- **Practice address fax:** (915) 779-2822
- **Mailing address:** 4305 N MESA ST STE B, EL PASO, TX 79902-1124
- **Mailing address phone:** (915) 778-7378
- **Mailing address fax:** (915) 779-2822

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RS0012X | Sleep Medicine (Internal Medicine) Physician | — | NULL | Yes |
| 207RS0012X | Sleep Medicine (Internal Medicine) Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/10/2019
- **Last updated:** 12/20/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 79570054 | — | NM |