Provider Demographics
NPI:1114023751
Name:DIAZ, MARY ANNE BORLAZA (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARY ANNE
Middle Name:BORLAZA
Last Name:DIAZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2732 ABORN RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121-1204
Mailing Address - Country:US
Mailing Address - Phone:408-532-7645
Mailing Address - Fax:408-532-7633
Practice Address - Street 1:2732 ABORN RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121-1204
Practice Address - Country:US
Practice Address - Phone:408-532-7645
Practice Address - Fax:408-532-7633
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA495101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice