Individual
MR. CARMELO O DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
660 S 200 E, STE 250, SALT LAKE CITY, UT 84111-3835
(801) 359-2256
Mailing address
PO BOX 10719, BAKERSFIELD, CA 93389-0719
(801) 310-0288
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA57869
CA
363AM0700X
Medical Physician Assistant
Primary
9453799-1206
UT
Other
Enumeration date
06/26/2015
Last updated
09/23/2021
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