Provider Demographics
NPI:1003480666
Name:DIAZ, NINA MARIE (SLPA)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:MARIE
Last Name:DIAZ
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6245 CAHUENGA BLVD APT 5
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-3900
Mailing Address - Country:US
Mailing Address - Phone:818-378-8158
Mailing Address - Fax:
Practice Address - Street 1:611 N BRAND BLVD # 100
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1221
Practice Address - Country:US
Practice Address - Phone:747-286-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASPA54022355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant