Provider Demographics
NPI:1316603517
Name:DIAZ, ALYSE (RCS)
Entity Type:Individual
Prefix:
First Name:ALYSE
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:RCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2935 CEDAR BROOK DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-6017
Mailing Address - Country:US
Mailing Address - Phone:404-556-5714
Mailing Address - Fax:
Practice Address - Street 1:2935 CEDAR BROOK DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-6017
Practice Address - Country:US
Practice Address - Phone:404-556-5714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography
No374U00000XNursing Service Related ProvidersHome Health Aide
No246W00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Cardiology