Provider Demographics
NPI:1487972477
Name:DIAZ, ELSI MARIA (MD)
Entity type:Individual
Prefix:DR
First Name:ELSI
Middle Name:MARIA
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELSI
Other - Middle Name:MARIA
Other - Last Name:DIAZ-HERNANDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:15920 S RANCHO SAHUARITA BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:SAHUARITA
Mailing Address - State:AZ
Mailing Address - Zip Code:85629-8013
Mailing Address - Country:US
Mailing Address - Phone:520-575-1175
Mailing Address - Fax:520-575-1183
Practice Address - Street 1:15920 S RANCHO SAHUARITA BLVD STE 120
Practice Address - Street 2:
Practice Address - City:SAHUARITA
Practice Address - State:AZ
Practice Address - Zip Code:85629-8013
Practice Address - Country:US
Practice Address - Phone:520-575-1175
Practice Address - Fax:520-575-1183
Is Sole Proprietor?:No
Enumeration Date:2010-05-14
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ43414207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ531955Medicaid