Provider Demographics
NPI:1891181087
Name:DIAZ, ANGELA (BS SLPA)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:BS SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9604 CAMINITO TIZONA
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4103
Mailing Address - Country:US
Mailing Address - Phone:619-820-0187
Mailing Address - Fax:
Practice Address - Street 1:9604 CAMINITO TIZONA
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4103
Practice Address - Country:US
Practice Address - Phone:619-820-0187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29812355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant