Provider Demographics
NPI:1801389366
Name:DIAZ, BRENDEN KYLE
Entity Type:Individual
Prefix:
First Name:BRENDEN
Middle Name:KYLE
Last Name:DIAZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 CAMPBELL BLVD
Mailing Address - Street 2:
Mailing Address - City:GETZVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14068-1500
Mailing Address - Country:US
Mailing Address - Phone:716-428-1229
Mailing Address - Fax:
Practice Address - Street 1:260 CAMPBELL BLVD
Practice Address - Street 2:
Practice Address - City:GETZVILLE
Practice Address - State:NY
Practice Address - Zip Code:14068-1500
Practice Address - Country:US
Practice Address - Phone:716-428-1229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-10
Last Update Date:2018-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management