Provider Demographics
NPI:1043287048
Name:DIAZ, CARLOS GILBERTO (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:GILBERTO
Last Name:DIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5102 W CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85031-1703
Mailing Address - Country:US
Mailing Address - Phone:602-655-1905
Mailing Address - Fax:602-655-9504
Practice Address - Street 1:202 E EARLL DR STE 200
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2647
Practice Address - Country:US
Practice Address - Phone:602-599-5434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ441372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ589408Medicaid
PRF44264Medicare UPIN