Organization
GONZALO A DIAZ
Active
Parent organization
GONZALO A DIAZ
Other names
Los Alamos
Organization subpart
Yes
Provider details
NPI number
Legal business name
GONZALO A DIAZ
Authorized official
GONZALO A DIAZ MD (OWNER)
(915) 779-7378
Entity
Organization
Contact information
Practice address
3917 WEST RD, LOS ALAMOS, NM 87544-2275
(915) 779-7378
(915) 779-2822
Mailing address
4305 N MESA ST STE B, EL PASO, TX 79902-1124
(915) 778-7378
(915) 779-2822
Taxonomy
Speciality
Code
Description
License number
State
207RS0012X
Sleep Medicine (Internal Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
79570054
—
NM
Enumeration date
12/10/2019
Last updated
12/20/2019
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