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MR. VICTOR ESTEVAN DIAZ AODC #1402
>> Community Health Worker >> Other Service ProvidersRegistrant NPI Number: 1205190964
Individual Registrant:MR. VICTOR ESTEVAN DIAZ AODC #1402
Gender: M
Not Sole Proprietor
Gender: M
Not Sole Proprietor
Location and contact information for practice:
505 M ST RIO LINDA, CA 95673 US
Tel: 916-287-4067 Fax: 916-287-4068
Tel: 916-287-4067 Fax: 916-287-4068
Contact information for business:
505 M ST RIO LINDA, CA 95673-2218 US
Tel: 916-228-4067 Fax: 919-228-4068
Tel: 916-228-4067 Fax: 919-228-4068
Registration Information:
NPI: 1205190964
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| N | 172V00000X | Other Service Providers Community Health Worker | ||
| Y | 171M00000X | Other Service Providers Case Manager/Care Coordinator |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| 171M00000X | CA | 05 |
