Provider Demographics
NPI:1952458549
Name:DIAZ, LISA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 NEWPORT CENTER DR
Mailing Address - Street 2:STE 261
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7506
Mailing Address - Country:US
Mailing Address - Phone:949-574-9709
Mailing Address - Fax:949-650-6235
Practice Address - Street 1:361 HOSPITAL RD
Practice Address - Street 2:STE 223
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3511
Practice Address - Country:US
Practice Address - Phone:949-574-9709
Practice Address - Fax:949-650-6235
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51213207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G02275Medicare UPIN