Provider Demographics
NPI:1255519773
Name:DIAZ, OSVALDO
Entity type:Individual
Prefix:MRS
First Name:OSVALDO
Middle Name:
Last Name:DIAZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 RANCHO DEL ORO DR APT 100
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-7308
Mailing Address - Country:US
Mailing Address - Phone:760-763-0565
Mailing Address - Fax:
Practice Address - Street 1:3D BATTALION 1ST MAR BATTALION AID STATION
Practice Address - Street 2:BOX 555422
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055
Practice Address - Country:US
Practice Address - Phone:760-763-0565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman