Provider Demographics
NPI:1922157288
Name:DIAZ, EDUARDO (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:
Last Name:DIAZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3638 EL CAJON BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-1500
Mailing Address - Country:US
Mailing Address - Phone:619-220-0548
Mailing Address - Fax:619-220-8604
Practice Address - Street 1:3638 EL CAJON BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-1500
Practice Address - Country:US
Practice Address - Phone:619-220-0548
Practice Address - Fax:619-220-8604
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2020-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA443061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1598990319OtherDENTICAL NPI