Provider Demographics
NPI:1407154461
Name:DIAZ, EDMUND JR (MS)
Entity Type:Individual
Prefix:MR
First Name:EDMUND
Middle Name:
Last Name:DIAZ
Suffix:JR
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 MARKET ST STE 400
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-1600
Mailing Address - Country:US
Mailing Address - Phone:415-487-3124
Mailing Address - Fax:415-558-9657
Practice Address - Street 1:1035 MARKET ST STE 400
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-1600
Practice Address - Country:US
Practice Address - Phone:415-487-3124
Practice Address - Fax:415-558-9657
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor