Provider Demographics
NPI:1255953311
Name:DIAZ, SHERYL LYNN CLARE (DO, MS)
Entity type:Individual
Prefix:
First Name:SHERYL LYNN
Middle Name:CLARE
Last Name:DIAZ
Suffix:
Gender:F
Credentials:DO, MS
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3737 MARTIN LUTHER KING JR BLVD STE 402
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-3533
Mailing Address - Country:US
Mailing Address - Phone:310-639-9363
Mailing Address - Fax:310-639-9251
Practice Address - Street 1:3737 MARTIN LUTHER KING JR BLVD STE 402
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-3533
Practice Address - Country:US
Practice Address - Phone:310-639-9363
Practice Address - Fax:310-639-9251
Is Sole Proprietor?:No
Enumeration Date:2020-05-12
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA390200000X
CA20A22220207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program