Provider Demographics
NPI:1831482629
Name:DIAZ, AMILCAR (MD)
Entity Type:Individual
Prefix:DR
First Name:AMILCAR
Middle Name:
Last Name:DIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26035 MOULTON PKWY # O229
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-6247
Mailing Address - Country:US
Mailing Address - Phone:858-335-5453
Mailing Address - Fax:
Practice Address - Street 1:101 THE CITY DRIVE SOUTH,
Practice Address - Street 2:UCI HEALTH DEPARTMENT OF RADIOLOGIC SCIENCE, SUITE 201
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:714-509-2526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-26
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1554262085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging