Active NPI
Jose Luis Diaz, MA6056739
- Specialist
- Tumwater, WA
National Provider Identifier
1265815260
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- MA 6056739
- Practice address
- 2330 Mottman Rd SW
Suite 106
Tumwater, WA 98512-6232 - Phone
- (360) 520-1917
- NPI assigned
- Jul 8, 2015
- Last updated
- Jul 8, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | MA 6056739 | WA | Primary |
Addresses
Primary practice location
2330 Mottman Rd SW
Suite 106
Tumwater, WA 98512-6232
Mailing address
312 Yauger Way NW #104
Olympia, WA 98502
Phone (360) 520-1917
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA 6056739 | WA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1436313600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1436313600000",
"number": "1265815260",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "312 YAUGER WAY NW #104",
"city": "OLYMPIA",
"state": "WA",
"postal_code": "98502",
"telephone_number": "360-520-1917"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2330 MOTTMAN RD SW",
"address_2": "SUITE 106",
"city": "TUMWATER",
"state": "WA",
"postal_code": "985126232",
"telephone_number": "360-520-1917"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIAZ",
"first_name": "JOSE",
"middle_name": "LUIS",
"credential": "MA6056739",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-07-08",
"last_updated": "2015-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "WA",
"license": "MA 6056739",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tumwater, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.