Provider Demographics
NPI:1336767334
Name:GARCIA DIAZ, PORFIRIO
Entity Type:Individual
Prefix:
First Name:PORFIRIO
Middle Name:
Last Name:GARCIA 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 1:930 W COOK ST APT 7
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-5463
Mailing Address - Country:US
Mailing Address - Phone:805-868-4612
Mailing Address - Fax:
Practice Address - Street 1:930 W COOK ST APT 7
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-5463
Practice Address - Country:US
Practice Address - Phone:805-868-4612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer