Provider Demographics
NPI:1801880638
Name:DIAZ, JULIO GABRIEL (MD)
Entity type:Individual
Prefix:
First Name:JULIO
Middle Name:GABRIEL
Last Name:DIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JULIO
Other - Middle Name:GABRIEL
Other - Last Name:DIAZ-ORTERO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:510 N MILPAS ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93103-3137
Mailing Address - Country:US
Mailing Address - Phone:805-962-8880
Mailing Address - Fax:805-957-1642
Practice Address - Street 1:510 N MILPAS ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93103-3137
Practice Address - Country:US
Practice Address - Phone:805-962-8880
Practice Address - Fax:805-957-1642
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36932207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00369320Medicaid
A84934Medicare UPIN
CAA36932Medicare ID - Type Unspecified