GUADALUPE YESSENIA DIAZ (DO) – Family Medicine Physician, NPI 1164088548

GUADALUPE YESSENIA DIAZ (DO) is a healthcare provider. based in Renton, Washington. specializing in FAMILY PRACTICE. They hold the professional credentials DO. They hold a License No. 20A22524 (CA). The NPI Number for GUADALUPE YESSENIA DIAZ (DO) is 1164088548

Main info

Female
5 Years Of Experience
Accepts Medicare Assignment
Name
GUADALUPE YESSENIA DIAZ (DO)
NPI
1164088548
Phone
Not provided
Address
1205 GRANT AVE S APT N203
Enumeration Date
11 May 2019
Last Update Date
2 January 2026

Doctor Profile

Medical School Name
AT STILL UN OF HLTH SCIENCES, COL OF OSTEO MED, MESA
Secondary Phone
5596644000
Graduation Year
2021 (5 years ago)
PAC ID
0749621084
Group Practice PAC ID
4880584317
Professional Enrollment ID
I20240516003686
Address ID
CA936383631MA344XXSTXX400
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience43
Completeness85
Years active:7State licenses:1Digital endpointsOther names

13,194 FAMILY PRACTICE in CA

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Provider Addresses for GUADALUPE YESSENIA DIAZ (DO)

  • 1205 GRANT AVE S APT N203

    RENTON, WA 980556025

    Phone:

    Type: Mailing

  • 12900, South Harris Avenue, East Compton, Compton, Los Angeles County, California, 90221, United States

    COMPTON, CA 902211723

    Phone: (310) 486-0855

    Type: Location

  • 2625 E DIVISADERO ST

    FRESNO, CA 937211431

    Phone: (559) 443-2682

    Fax: (559) 443-2681

    Type: Mailing

  • 2823 FRESNO ST

    FRESNO, CA 937211324

    Phone: (554) 436-2682

    Fax: (559) 443-2681

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2024-05-16

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20240516003686IFamily PracticeCATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 98055)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 4880584317View full group profile
NameSpecialtyState
Nurse PractitionerTX
Internal MedicineCA
Internal MedicineCA
-CA
Family PracticeTX
Family PracticeCA
Pain ManagementCA
Physician AssistantCA
Family PracticeCA
Family PracticeCA

Reviews

All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.

No reviews yet. Be the first to share your experience — your opinion helps families compare providers.

Frequently asked questions

How do payers reference GUADALUPE YESSENIA DIAZ (DO)?
For GUADALUPE YESSENIA DIAZ (DO), use NPI 1164088548 as the unique 10-digit identifier.
Would GUADALUPE YESSENIA DIAZ (DO) appear as active to a payer?
You can treat GUADALUPE YESSENIA DIAZ (DO) as active for directory purposes; confirm clinical privileges separately.
How would a patient describe GUADALUPE YESSENIA DIAZ (DO)'s focus?
For GUADALUPE YESSENIA DIAZ (DO), the primary taxonomy reads as Family Medicine Physician. Clinical services aligned with this taxonomy classification.
Where in Washington is GUADALUPE YESSENIA DIAZ (DO) registered?
Use Renton, Washington as the headline location for GUADALUPE YESSENIA DIAZ (DO) here.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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