Nestor Diaz, DMD
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Stickney, IL
NPI 1659174332 · NPPES record last updated Jun 27, 2025
Key facts
- NPI
- 1659174332
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- License
- 019.036103 (IL)
- Practice address
- 3930 Oak Park Ave
Stickney, IL 60402-4168 - Phone
- (708) 491-0002
- NPI assigned
- Mar 29, 2025
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.036103 | IL | MD | Student in an Organized Health Care Education/Training Program |
Interoperability endpoints
- ndiaz188951@uihealth.direct-ci.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | 019.036103 | IL | Yes |
Addresses
Primary practice location
3930 Oak Park Ave
Stickney, IL 60402-4168
Mailing address
3930 Oak Park Ave
Stickney, IL 60402-4168
Phone (708) 491-0002
Other providers in Stickney, IL
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- Janine Bednarz
- Kinzy Kanisha Frizzle
- Desiree Gonzalez
- Cristopher Guzman
- Emily Jacobs
- Tami Lynn Jimenez
All providers in Stickney, IL · Student in an Organized Health Care Education/Training Program in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 27, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.