Provider Demographics
NPI:1114094224
Name:DIAZ, SELINA MARIE
Entity Type:Individual
Prefix:
First Name:SELINA
Middle Name:MARIE
Last Name: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 1:51 N CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-1406
Mailing Address - Country:US
Mailing Address - Phone:845-255-3601
Mailing Address - Fax:845-255-3498
Practice Address - Street 1:51 N CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-1406
Practice Address - Country:US
Practice Address - Phone:845-255-3601
Practice Address - Fax:845-255-3498
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator