Provider Demographics
NPI:1245655588
Name:DIAZ, RAY GEORGE (CERTIFIED ORTHOTIST)
Entity type:Individual
Prefix:
First Name:RAY
Middle Name:GEORGE
Last Name:DIAZ
Suffix:
Gender:M
Credentials:CERTIFIED ORTHOTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4479 STONERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-8448
Mailing Address - Country:US
Mailing Address - Phone:925-484-6400
Mailing Address - Fax:
Practice Address - Street 1:4479 STONERIDGE DR
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-8448
Practice Address - Country:US
Practice Address - Phone:925-484-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-24
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist