Most Relevant Information
Provider Data
| NPI Number: | 1003317173 |
| Provider Name: | IVIS DIAZ |
| Entity Type: | Individual |
| Taxonomy Code: | 3747P1801X |
| Specialty: | Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 02/23/2018 |
| Last Updated: | 02/23/2018 |
Provider Practice Location
417 FOXVALE AVE
NORTH LAS VEGAS
NV
890326150
Practice Location Phone/Fax
| Phone: | 7024630082 |
| Fax: | 7026431552 |
Provider Mailing Location
417 FOXVALE AVE
NORTH LAS VEGAS
NV
890326150
Provider Mailing Phone/Fax
| Phone: | 7024630082 |
| Fax: | 7026431552 |