Provider Demographics
NPI:1619286978
Name:DIAZ, OMAIRA ISABEL (MSW)
Entity Type:Individual
Prefix:MRS
First Name:OMAIRA
Middle Name:ISABEL
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1066 BAYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-2738
Mailing Address - Country:US
Mailing Address - Phone:510-669-5053
Mailing Address - Fax:
Practice Address - Street 1:205 39TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94805-2212
Practice Address - Country:US
Practice Address - Phone:510-412-5930
Practice Address - Fax:510-412-0567
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1041C0700X
NY0833431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWVE061OtherAGENCY MEDICARE ID
NY1285628552OtherAGENCY NPI
NY00355940OtherANGENCY MEDICAID PROVIDER ID