Provider Demographics
NPI:1447916960
Name:DIAZ, JOSEPH LINCOLN JR
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:LINCOLN
Last Name:DIAZ
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 VICTOR WHARF ACCESS RD
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-3400
Mailing Address - Country:US
Mailing Address - Phone:808-474-2532
Mailing Address - Fax:808-474-9495
Practice Address - Street 1:2001 VICTOR WHARF ACCESS RD
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-3400
Practice Address - Country:US
Practice Address - Phone:808-474-2532
Practice Address - Fax:808-474-9495
Is Sole Proprietor?:No
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician
Provider Identifiers
StateIdentifier IDID TypeIssuer
1125287944OtherTRICARE