John Joseph Corrales-Diaz, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD00021573 Issued in WA

Practice address

19245 7TH Ave NE
Poulsbo, WA 98370-6551

Phone

(360) 782-3500

Fax

(360) 782-3540

NPI assigned

May 12, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: john.corralesdiaz@tdc.directbygreenway.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678060800000",
    "number": "1013967512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19245 7TH AVE NE",
            "city": "POULSBO",
            "state": "WA",
            "postal_code": "983706551",
            "telephone_number": "360-782-3500",
            "fax_number": "360-782-3540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19245 7TH AVE NE",
            "city": "POULSBO",
            "state": "WA",
            "postal_code": "983706551",
            "telephone_number": "360-782-3500",
            "fax_number": "360-782-3540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORRALES-DIAZ",
        "first_name": "JOHN",
        "middle_name": "JOSEPH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-12",
        "last_updated": "2023-03-06",
        "certification_date": "2023-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD00021573",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "CO7915",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4586742",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000428",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "john.corralesdiaz@tdc.directbygreenway.com",
            "affiliation": "Y",
            "affiliationName": "Franciscan Medical Group",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "450 S Kitsap Blvd Ste 250",
            "city": "Port Orchard",
            "state": "WA",
            "country_code": "US",
            "postal_code": "983663739",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Sally L Conrad, PA-C
• Elias Cook, DPT
• Janet R. Cook, RPH..
• Joan M. Cook, P.T.
• Craig Cooper
• Danette Costello, LMP
• Barbara Christine Coven-Ellis, SLP
• Roger L Cox, PA-C
• Virginia Cox
• Laura Sample Coykendall, PT

• Pediatrics Physician in Poulsbo, WA
• Providers in Poulsbo, WA by specialty
• Pediatrics Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.