Provider Demographics
NPI:1073067450
Name:DIEZ, THIERRY
Entity Type:Individual
Prefix:
First Name:THIERRY
Middle Name:
Last Name:DIEZ
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 1:6032 TERSKY CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122-3443
Mailing Address - Country:US
Mailing Address - Phone:702-601-9381
Mailing Address - Fax:702-287-2832
Practice Address - Street 1:6032 TERSKY CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89122-3443
Practice Address - Country:US
Practice Address - Phone:702-601-9381
Practice Address - Fax:702-287-2832
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV20161209961171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor