Provider Demographics
NPI:1467746206
Name:DIAZ MEDINA, MARCIA PATRICIA (MD)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:PATRICIA
Last Name:DIAZ MEDINA
Suffix:
Gender:F
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:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:TOPPENISH
Mailing Address - State:WA
Mailing Address - Zip Code:98948-0190
Mailing Address - Country:US
Mailing Address - Phone:509-865-2395
Mailing Address - Fax:509-865-0757
Practice Address - Street 1:8935 SE POWELL BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-1938
Practice Address - Country:US
Practice Address - Phone:503-772-4335
Practice Address - Fax:503-772-4337
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD166901207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine