Provider Demographics
NPI:1871516492
Name:DIAZ, NATALIE (MD)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
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 1:21840 NORMANDIE AVE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-2047
Mailing Address - Country:US
Mailing Address - Phone:310-222-5189
Mailing Address - Fax:310-782-6786
Practice Address - Street 1:5215 TORRANCE BLVD STE 300
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4009
Practice Address - Country:US
Practice Address - Phone:424-212-5361
Practice Address - Fax:310-316-3466
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA866492084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACH1382OtherRAILROAD MEDICARE
CAW14940OtherFPP
CAM050376OtherHARBOR UCLA
CADA6447OtherRAILROAD MEDICARE
CADA6447OtherRAILROAD MEDICARE
CA123574Medicare UPIN
CAWA86649CMedicare PIN
CAWA8649BMedicare PIN