Individual
MR. HECTOR DIAZ JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
4577 ACACIA AVE APT 7, LA MESA, CA 91941-6478
(619) 709-4961
Mailing address
4577 ACACIA AVE APT 7, LA MESA, CA 91941-6478
(619) 709-4961
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1291997941
DOD ID
—
Enumeration date
09/29/2015
Last updated
09/29/2015
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