Provider Information for 1871083105
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RAYMOND DIAZ
Sex: Male
NPI: 1871083105
Last Updated: 2021-01-25
Certification Date: 2021-01-25
Certification Date: 2021-01-25
Details
| Name | Value | ||||||||||||
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| NPI | 1871083105 | ||||||||||||
| Enumeration Date | 2018-05-11 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 1105 E FLORIDA AVE HEMET, CA 92543-4512 United States Phone: | Fax: | ||||||||||||
| Primary Practice Address | 1105 E FLORIDA AVE HEMET, CA 92543-4512 United States Phone: 951-439-2939 | Fax: | ||||||||||||
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