Individual
GENE IAN DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
537 E VINE AVE, WEST COVINA, CA 91790-5126
(888) 763-4963
Mailing address
18826 ALTARIO ST, LA PUENTE, CA 91744-6107
(626) 241-5595
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
49288
CA
Other
Enumeration date
12/08/2020
Last updated
12/08/2020
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