Basic Information
| Provider Information | |||||||||
| NPI: | 1518428812 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | DIAZ | ||||||||
| FirstName: | ALEXANDER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1959 NE PACIFIC ST FL 2 | ||||||||
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| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981950001 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 75 SOUTH BASCOM AVE | ||||||||
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| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4088855000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2019 | ||||||||
| LastUpdateDate: | 07/01/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | ML.61058073 | WA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.