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Organization
MARIO A DIAZ-GOMEZ, M.D., A PROFESSIONAL CORPORATION
Active
Organization
MARIO A DIAZ-GOMEZ, M.D., A PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIO A DIAZ-GOMEZ M.D. (PHYSICIAN)
(909) 303-3074
Entity
Organization
Contact information
Practice address
360 E 7TH ST STE L, UPLAND, CA 91786-6701
(909) 303-3074
(909) 303-3090
Mailing address
360 E 7TH ST, SUITE D, UPLAND, CA 91786-6701
(909) 981-2500
(909) 981-2509
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
G564320
—
CA
Enumeration date
04/16/2015
Last updated
12/22/2021
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