Provider Demographics
NPI:1154441145
Name:DIAZ, MARIA (FP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:FP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13602 N 44TH ST
Mailing Address - Street 2:#150
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-6341
Mailing Address - Country:US
Mailing Address - Phone:602-297-4482
Mailing Address - Fax:
Practice Address - Street 1:13602 N 44TH ST
Practice Address - Street 2:#150
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-6341
Practice Address - Country:US
Practice Address - Phone:602-297-4482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ969800Medicaid