Provider Demographics
NPI:1114482783
Name:DIAZ, GENARO F (RCP)
Entity Type:Individual
Prefix:
First Name:GENARO
Middle Name:F
Last Name:DIAZ
Suffix:
Gender:M
Credentials:RCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1779 W YOSEMITE AVE
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-5130
Mailing Address - Country:US
Mailing Address - Phone:209-824-4200
Mailing Address - Fax:
Practice Address - Street 1:1779 W YOSEMITE AVE
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-5130
Practice Address - Country:US
Practice Address - Phone:209-824-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-07
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA259032279P1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279P1004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredPulmonary Diagnostics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA25903OtherRCP