Individual
MR. KIMI SAN MIGUEL DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, PA-C
Contact information
Practice address
300 JUBILEE DR, PEABODY, MA 01960-4068
(978) 513-7588
Mailing address
PO BOX 163, MONGAUP VALLEY, NY 12762-0163
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
NY
Other
Enumeration date
01/19/2023
Last updated
10/23/2023
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