Individual
JOSE LUIS DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA6056739
Contact information
Practice address
2330 MOTTMAN RD SW, SUITE 106, TUMWATER, WA 98512-6232
(360) 520-1917
Mailing address
312 YAUGER WAY NW #104, OLYMPIA, WA 98502
(360) 520-1917
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA 6056739
WA
Other
Enumeration date
07/08/2015
Last updated
07/08/2015
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