Provider Demographics
NPI:1710102272
Name:DIAZ INTERNAL MEDICINE AND PEDIATRICS
Entity Type:Organization
Organization Name:DIAZ INTERNAL MEDICINE AND PEDIATRICS
Other - Org Name:ARIZONA MEDICAL INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:VICENTE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ-GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-536-7600
Mailing Address - Street 1:14175 W INDIAN SCHOOL RD
Mailing Address - Street 2:SUITE B4 605
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-8369
Mailing Address - Country:US
Mailing Address - Phone:623-536-7600
Mailing Address - Fax:623-536-7828
Practice Address - Street 1:3050 N LITCHFIELD RD
Practice Address - Street 2:SUITE 130
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-7804
Practice Address - Country:US
Practice Address - Phone:623-536-7600
Practice Address - Fax:623-536-7828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31532207R00000X
208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ332069Medicaid
AZH42474Medicare UPIN
AZ332069Medicaid