Provider Demographics
NPI:1346379583
Name:DIAZ, TARCISIO CALIBO (MD)
Entity Type:Individual
Prefix:MR
First Name:TARCISIO
Middle Name:CALIBO
Last Name:DIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S MAIN STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-3554
Mailing Address - Country:US
Mailing Address - Phone:951-738-9081
Mailing Address - Fax:951-738-9081
Practice Address - Street 1:900 S MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-3401
Practice Address - Country:US
Practice Address - Phone:951-738-9081
Practice Address - Fax:951-738-9081
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46295207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A462950Medicare ID - Type Unspecified
CAB43904Medicare UPIN