Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 135890 | CA |
N | 2081S0010X | Sports Medicine | 135890 | CA |
N | 213ES0000X | Sports Medicine | 135890 | CA |
N | 2081S0010X | Sports Medicine | 258020 | NY |
N | 213ES0000X | Sports Medicine | 258020 | NY |
NPI | 1437356094 |
---|---|
Provider Name | Mirielle Diaz-Molina |
First Address | San Diego, CA 92111-3635 |
Second Address | San Diego, CA 92111-3635 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2007 |
Last Update Date | 05/12/2021 |