Provider Demographics
NPI:1891135752
Name:TARCISIO C. DIAZ, M.D. A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:TARCISIO C. DIAZ, M.D. A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TARCISIO
Authorized Official - Middle Name:CALIBO
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-738-9081
Mailing Address - Street 1:900 S MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-3401
Mailing Address - Country:US
Mailing Address - Phone:951-738-9081
Mailing Address - Fax:951-738-9081
Practice Address - Street 1:900 S MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-3401
Practice Address - Country:US
Practice Address - Phone:951-738-9081
Practice Address - Fax:951-738-9081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46295207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A462950OtherMEDICARE
CA00A462950OtherMEDICARE