Provider Demographics
NPI:1447678149
Name:DIAZ MELEAN, CARLOS MANUEL (MD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:MANUEL
Last Name:DIAZ MELEAN
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:OLIVEWOOD PEDIATRICS
Mailing Address - Street 2:1190 OLIVEWOOD DRIVE SUITE B
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348
Mailing Address - Country:US
Mailing Address - Phone:559-353-5700
Mailing Address - Fax:559-353-5708
Practice Address - Street 1:1190 OLIVEWOOD DR STE B
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-1256
Practice Address - Country:US
Practice Address - Phone:559-353-5700
Practice Address - Fax:559-353-5708
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA148789208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program