Mario a Diaz-Gomez, M.D., a Professional Corporation

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

MARIO A DIAZ-GOMEZ, M.D., A PROFESSIONAL CORPORATION

Practice address

360 E 7TH St Ste L
Upland, CA 91786-6701

Phone

(909) 303-3074

Fax

(909) 303-3090

NPI assigned

Apr 16, 2015

Organization subpart

No

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

Authorized official

Name

Mario A Diaz-Gomez, M.D.

Title

Physician

Phone

(909) 303-3074

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1429142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640131200000",
    "number": "1801283916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 E 7TH ST",
            "address_2": "SUITE D",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917866701",
            "telephone_number": "909-981-2500",
            "fax_number": "909-981-2509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 E 7TH ST STE L",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917866701",
            "telephone_number": "909-303-3074",
            "fax_number": "909-303-3090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIO A DIAZ-GOMEZ, M.D., A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-16",
        "last_updated": "2021-12-22",
        "certification_date": "2021-12-22",
        "status": "A",
        "authorized_official_last_name": "DIAZ-GOMEZ",
        "authorized_official_first_name": "MARIO",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "909-303-3074",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G564320",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Upland, CA
• Providers in Upland, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2021; 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.