Provider Demographics
NPI:1609115302
Name:DIAZ, ROSALIE CHRISTINE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROSALIE
Middle Name:CHRISTINE
Last Name:DIAZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14819 59A AVENUE
Mailing Address - Street 2:
Mailing Address - City:SURREY
Mailing Address - State:BC
Mailing Address - Zip Code:V3S 2W6
Mailing Address - Country:CA
Mailing Address - Phone:778-960-6762
Mailing Address - Fax:
Practice Address - Street 1:120-16555 FRASER HWY
Practice Address - Street 2:
Practice Address - City:SURREY
Practice Address - State:BC
Practice Address - Zip Code:V4N OE9
Practice Address - Country:CA
Practice Address - Phone:604-575-2325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral