Provider Demographics
NPI:1548753213
Name:SANTOS GARCIA, DIANA ABIGAIL
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:ABIGAIL
Last Name:SANTOS GARCIA
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 1:1101 W MOANA LN STE 2
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-4734
Mailing Address - Country:US
Mailing Address - Phone:775-337-2394
Mailing Address - Fax:775-507-7079
Practice Address - Street 1:3100 MILL ST STE 215
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502
Practice Address - Country:US
Practice Address - Phone:775-507-7078
Practice Address - Fax:775-507-7079
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician