Organization
J. MANUEL GONZALEZ-DIAZ M.D.
Active
Organization
J. MANUEL GONZALEZ-DIAZ M.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CHRISTINE GRACE HALVERSON (INSURANCE BILLING)
(818) 994-6177
Entity
Organization
Contact information
Practice address
13500 VAN NUYS BLVD, PACOIMA, CA 91331-3028
(818) 896-2999
(818) 896-8449
Mailing address
13500 VAN NUYS BLVD, PACOIMA, CA 91331-3028
(818) 896-2999
(818) 896-8449
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
LAB62080F
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0086101
—
CA
Enumeration date
10/09/2007
Last updated
10/09/2007
Update your record
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