Provider Demographics
NPI:1659174332
Name:DIAZ, NESTOR
Entity type:Individual
Prefix:
First Name:NESTOR
Middle Name:
Last Name:DIAZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3930 OAK PARK AVE
Mailing Address - Street 2:
Mailing Address - City:STICKNEY
Mailing Address - State:IL
Mailing Address - Zip Code:60402-4168
Mailing Address - Country:US
Mailing Address - Phone:708-491-0002
Mailing Address - Fax:
Practice Address - Street 1:3930 OAK PARK AVE
Practice Address - Street 2:
Practice Address - City:STICKNEY
Practice Address - State:IL
Practice Address - Zip Code:60402-4168
Practice Address - Country:US
Practice Address - Phone:708-491-0002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-29
Last Update Date:2025-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program