Provider Demographics
NPI:1407402753
Name:DIAZ, VICTORIA S
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:S
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 1:2100 SANTA CLARA DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-2615
Mailing Address - Country:US
Mailing Address - Phone:702-539-0250
Mailing Address - Fax:
Practice Address - Street 1:2100 SANTA CLARA DRIVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-2615
Practice Address - Country:US
Practice Address - Phone:702-539-0250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider