Provider Demographics
NPI:1801994082
Name:DIAZ, MANUEL CARLOS JR (DO)
Entity type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:CARLOS
Last Name:DIAZ
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:475 PIONEER AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95776-4905
Practice Address - Country:US
Practice Address - Phone:530-406-5600
Practice Address - Fax:530-406-5626
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A7575207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0071910Medicaid
CA020A75753Medicare PIN
CAGR0071910Medicaid
CAZZZ13144ZMedicare ID - Type Unspecified