Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | A112035 | CA |
NPI | 1124261110 |
---|---|
Provider Name | Roberto Ivan Diaz |
First Address | Los Altos, CA 94022-1408 |
Second Address | Mountain View, CA 94040-2833 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2009 |
Last Update Date | 10/12/2020 |