Provider Demographics
NPI:1831745637
Name:DIAZ, HECTOR ALEJANDRO
Entity type:Individual
Prefix:
First Name:HECTOR
Middle Name:ALEJANDRO
Last Name: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 1:660 E LOS ANGELES AVE STE B2
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-1884
Mailing Address - Country:US
Mailing Address - Phone:805-522-1844
Mailing Address - Fax:805-522-5345
Practice Address - Street 1:660 E LOS ANGELES AVE STE B2
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-1884
Practice Address - Country:US
Practice Address - Phone:805-522-1844
Practice Address - Fax:805-522-5345
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292966164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse