Individual
MR. JUAN CARLOS DIAZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CSA
Contact information
Practice address
1433 W FLOURNOY ST APT 3F, CHICAGO, IL 60607-3213
(786) 658-0280
Mailing address
1433 W FLOURNOY ST APT 3F, CHICAGO, IL 60607-3213
(786) 658-0280
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
238000684
IL
Other
Enumeration date
06/20/2020
Last updated
06/20/2020
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