Provider Demographics
NPI:1821600420
Name:DIAZ DIAZ, HIRAM GREAT (CRNA)
Entity Type:Individual
Prefix:DR
First Name:HIRAM
Middle Name:GREAT
Last Name:DIAZ DIAZ
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7916 E WOODSBORO AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-2435
Mailing Address - Country:US
Mailing Address - Phone:949-257-5734
Mailing Address - Fax:
Practice Address - Street 1:7916 E WOODSBORO AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-2435
Practice Address - Country:US
Practice Address - Phone:949-257-5734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-17
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95066307163WC0200X
CA95002190367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine