Doctor Name: | JOSE MANUEL GONZALEZ-DIAZ |
NPI Number: | 1205927415 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | A41311 |
Business Practice Address: | 13500 Van Nuys Blvd Pacoima, CA - 91331 |
Business Phone Number: | 8188962999 |
Business Fax Number: | 8188968449 |
Mailing Address: | 13500 Van Nuys Blvd, PACOIMA |
State: | CA |
Postal Code: | 91331 |
Phone Number: | 8188962999 |
Fax Number: | 8188968449 |
NPI Enumeration Date: | 09/27/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | A41311 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |