Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 59146 | GA |
N | 2081P2900X | Pain Medicine | 59146 | GA |
NPI | 1194751024 |
---|---|
Provider Name | Ruben Diaz |
First Address | Lawrenceville, GA 30045-5466 |
Second Address | Lawrenceville, GA 30045-5466 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 07/05/2021 |