Provider Demographics
NPI:1023570090
Name:DIAZ, JAN MICHAEL VINCENT GALANG
Entity Type:Individual
Prefix:
First Name:JAN MICHAEL VINCENT
Middle Name:GALANG
Last Name:DIAZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 CARNEGIE ST UNIT 921
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4512
Mailing Address - Country:US
Mailing Address - Phone:661-607-6014
Mailing Address - Fax:
Practice Address - Street 1:4270 S DECATUR BLVD STE B5
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-6802
Practice Address - Country:US
Practice Address - Phone:725-220-4200
Practice Address - Fax:725-220-4199
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV816419363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health