Provider Demographics
NPI:1659677011
Name:DIAZ, EDELMIRA I (MSW)
Entity Type:Individual
Prefix:
First Name:EDELMIRA
Middle Name:I
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 1:1908 SENTER RD
Mailing Address - Street 2:SUITE 50
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-2629
Mailing Address - Country:US
Mailing Address - Phone:408-200-0987
Mailing Address - Fax:408-279-1437
Practice Address - Street 1:1908 SENTER RD
Practice Address - Street 2:SUITE 50
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-2629
Practice Address - Country:US
Practice Address - Phone:408-200-0987
Practice Address - Fax:408-279-1437
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-02
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator