Provider Demographics
NPI:1851521082
Name:DIAZ, JOSE FERNANDO (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:FERNANDO
Last Name:DIAZ
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:54 SUTTON PL
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-1470
Mailing Address - Country:US
Mailing Address - Phone:413-395-7579
Mailing Address - Fax:
Practice Address - Street 1:300 STAFFORD ST STE 101
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-3581
Practice Address - Country:US
Practice Address - Phone:413-732-1928
Practice Address - Fax:413-733-5604
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2021-06-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MAPA3803363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant