Provider Demographics
NPI:1609461169
Name:DIAZ, IGNACIO (RN)
Entity Type:Individual
Prefix:
First Name:IGNACIO
Middle Name:
Last Name:DIAZ
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10510 MARSEN ST
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-1546
Mailing Address - Country:US
Mailing Address - Phone:626-652-2650
Mailing Address - Fax:
Practice Address - Street 1:10510 MARSEN ST
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-1546
Practice Address - Country:US
Practice Address - Phone:626-652-2650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-06
Last Update Date:2021-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95070155163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine