| Diaz Medical Group Inc | |
|
14550 Archwood St Ste B Van Nuys CA 91405-4628 | |
| (909) 217-8633 | |
| Not Available |
| Full Name | Diaz Medical Group Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 14550 Archwood St Ste B, Van Nuys, California |
| Authorized Official Name and Position | King Nino Diaz (NURSE PRACTITIONER) |
| Authorized Official Contact | 9092178633 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Diaz Medical Group Inc 14550 Archwood St Ste B Van Nuys CA 91405-4628 Ph: (909) 217-8633 | Diaz Medical Group Inc 14550 Archwood St Ste B Van Nuys CA 91405-4628 Ph: (909) 217-8633 |
| NPI Number | 1669139945 |
|---|---|
| Provider Enumeration Date | 11/22/2021 |
| Last Update Date | 11/22/2021 |
| Medicare PECOS PAC ID | 1052707403 |
|---|---|
| Medicare Enrollment ID | O20220412000303 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669139945 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Gholamreza Vafadouste |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1164470639 PECOS PAC ID: 2264331123 Enrollment ID: I20040112000096 |
| Provider Name | Stephen N Pine |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1356352108 PECOS PAC ID: 8022055672 Enrollment ID: I20050414000739 |
| Provider Name | Dmitriy Romanenko |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1881894715 PECOS PAC ID: 6406925114 Enrollment ID: I20080521000517 |
| Provider Name | King Nino Tadeo Diaz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144841172 PECOS PAC ID: 2961810957 Enrollment ID: I20210412001184 |
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