Provider Demographics
NPI:1730534843
Name:DIAZ, JENNA NATALIA (MD)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:NATALIA
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3196 S MARYLAND PKWY STE 309
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-2314
Mailing Address - Country:US
Mailing Address - Phone:702-791-0477
Mailing Address - Fax:702-791-6831
Practice Address - Street 1:3196 S MARYLAND PKWY STE 309
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2314
Practice Address - Country:US
Practice Address - Phone:702-791-0477
Practice Address - Fax:702-791-6831
Is Sole Proprietor?:No
Enumeration Date:2016-04-26
Last Update Date:2025-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019017047208000000X
390200000X
NV221622080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program