Individual
DR. GLENN FELIX TAN DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2825 SIENA HEIGHTS DR STE 101, HENDERSON, NV 89052-3976
(702) 616-7049
(702) 492-1467
Mailing address
6355 S BUFFALO DR FL 3, LAS VEGAS, NV 89113-2133
(702) 216-3346
(702) 671-6883
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20627
NV
207Q00000X
Family Medicine Physician
246006
MA
207Q00000X
Family Medicine Physician
A73348
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1487695466
—
NV
01
—
20627
STATE LICENSE
NV
Enumeration date
06/09/2006
Last updated
10/17/2022
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