Provider Demographics
NPI:1750840922
Name:DIAZ ARVIZU, MARIA (FNP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:DIAZ ARVIZU
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2708 MADRID CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-2070
Mailing Address - Country:US
Mailing Address - Phone:323-698-2380
Mailing Address - Fax:
Practice Address - Street 1:3529 FIRESTONE BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-3031
Practice Address - Country:US
Practice Address - Phone:323-566-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95011422207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine