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Individual

JACKIE E DIAZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LVN

Contact information

Practice address
5202 UNIVERSITY AVE, CENTRAL REGION PUBLIC HEALTH CENTER, SAN DIEGO, CA 92105-2268
(619) 229-5400
Mailing address
512 ALAMITOS WAY, SAN MARCOS, CA 92078-6158
(760) 727-5510

Taxonomy

Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
213510
CA

Other

Enumeration date
05/03/2010
Last updated
08/25/2010
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