Provider Demographics
NPI:1750823910
Name:DIAZ, JOE CASTILLO III (LPT)
Entity Type:Individual
Prefix:MR
First Name:JOE
Middle Name:CASTILLO
Last Name:DIAZ
Suffix:III
Gender:M
Credentials:LPT
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Mailing Address - Street 1:1667 VEJAR ST
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-2530
Mailing Address - Country:US
Mailing Address - Phone:909-568-3126
Mailing Address - Fax:
Practice Address - Street 1:3881 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90062-1105
Practice Address - Country:US
Practice Address - Phone:323-290-4349
Practice Address - Fax:323-293-8159
Is Sole Proprietor?:No
Enumeration Date:2016-11-04
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPT37201167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician