Provider Demographics
NPI:1255431060
Name:DIAZ, HERMINIA P (RPT)
Entity type:Individual
Prefix:
First Name:HERMINIA
Middle Name:P
Last Name:DIAZ
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8066 EPPICK CT
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91945-4455
Mailing Address - Country:US
Mailing Address - Phone:619-840-2404
Mailing Address - Fax:619-668-0128
Practice Address - Street 1:651 E PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3053
Practice Address - Country:US
Practice Address - Phone:760-291-0074
Practice Address - Fax:760-291-0076
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT17606225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00443465OtherRAILROAD MEDICARE
CAWPT17606AMedicare PIN
CAP00443465OtherRAILROAD MEDICARE