Individual
MR. DEREK DENNIS DIAZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2333 N 6TH ST, GRAND JUNCTION, CO 81501
(970) 298-1782
(970) 692-8301
Mailing address
2333 N 6TH ST, GRAND JUNCTION, CO 81501-2001
(970) 298-1782
(970) 244-3043
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
4748
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9000143760
—
CO
Enumeration date
12/06/2011
Last updated
05/11/2020
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