Provider Demographics
NPI:1134161144
Name:DIAZ, GUILLERMO JR (MD)
Entity type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:
Last Name:DIAZ
Suffix:JR
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 1:350 S FIGUEROA ST STE 990
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90071-1308
Mailing Address - Country:US
Mailing Address - Phone:213-288-9000
Mailing Address - Fax:
Practice Address - Street 1:2829 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-3304
Practice Address - Country:US
Practice Address - Phone:213-699-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86465208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics