Basic Information
| Provider Information | |||||||||
| NPI: | 1447678149 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DIAZ MELEAN | ||||||||
| FirstName: | CARLOS | ||||||||
| MiddleName: | MANUEL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | OLIVEWOOD PEDIATRICS | ||||||||
| Address2: | 1190 OLIVEWOOD DRIVE SUITE B | ||||||||
| City: | MERCED | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5593535700 | ||||||||
| FaxNumber: | 5593535708 | ||||||||
| Practice Location | |||||||||
| Address1: | 1190 OLIVEWOOD DR STE B | ||||||||
| Address2: | |||||||||
| City: | MERCED | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953481256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5593535700 | ||||||||
| FaxNumber: | 5593535708 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2014 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208000000X | A148789 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.