| Gervacio D Diaz Iii Md Inc | |
|
2013 Coffee Rd Modesto CA 95355-2405 | |
| (209) 529-8506 | |
| (209) 529-8524 |
| Full Name | Gervacio D Diaz Iii Md Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2013 Coffee Rd, Modesto, California |
| Authorized Official Name and Position | Gervacio D Diaz (PRESIDENT) |
| Authorized Official Contact | 2095298506 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gervacio D Diaz Iii Md Inc 2013 Coffee Rd Modesto CA 95355-2405 Ph: (209) 529-8506 | Gervacio D Diaz Iii Md Inc 2013 Coffee Rd Modesto CA 95355-2405 Ph: (209) 529-8506 |
| NPI Number | 1437221025 |
|---|---|
| Provider Enumeration Date | 11/15/2006 |
| Last Update Date | 03/13/2023 |
| Medicare PECOS PAC ID | 5496755779 |
|---|---|
| Medicare Enrollment ID | O20070110000553 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437221025 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | A69801 (California) | Primary |
| Provider Name | Gervacio Daniel Diaz |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1700835451 PECOS PAC ID: 7911906219 Enrollment ID: I20061214000411 |
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