Provider Demographics
NPI:1316091507
Name:GOICURIA-DIAZ, TANIA
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:GOICURIA-DIAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 TYDD ST
Mailing Address - Street 2:APT#4D
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-1265
Mailing Address - Country:US
Mailing Address - Phone:254-458-6385
Mailing Address - Fax:707-839-6178
Practice Address - Street 1:1001 LYCOMING AVE
Practice Address - Street 2:MEDICAL
Practice Address - City:MCKINLEYVILLE
Practice Address - State:CA
Practice Address - Zip Code:95519-9308
Practice Address - Country:US
Practice Address - Phone:707-839-6176
Practice Address - Fax:707-839-6178
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other