Active NPI
Gene Ian Diaz, PTA
- Physical Therapy Assistant
- West Covina, CA
National Provider Identifier
1851997522
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 49288
- Practice address
- 537 E Vine Ave
West Covina, CA 91790-5126 - Phone
- (888) 763-4963
- NPI assigned
- Dec 8, 2020
- 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 |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 49288 | CA | Primary |
Addresses
Primary practice location
537 E Vine Ave
West Covina, CA 91790-5126
Mailing address
18826 Altario St
La Puente, CA 91744-6107
Phone (626) 241-5595
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 |
|---|---|---|---|
| 49288 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1607385600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1607385600000",
"number": "1851997522",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18826 ALTARIO ST",
"city": "LA PUENTE",
"state": "CA",
"postal_code": "917446107",
"telephone_number": "626-241-5595"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "537 E VINE AVE",
"city": "WEST COVINA",
"state": "CA",
"postal_code": "917905126",
"telephone_number": "888-763-4963"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIAZ",
"first_name": "GENE",
"middle_name": "IAN",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-12-08",
"last_updated": "2020-12-08",
"certification_date": "2020-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "CA",
"license": "49288",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Covina, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.