Provider Demographics
NPI:1891420816
Name:DIAZ LUNA, NICOLETTE CYNTHIA (SLP INTERN)
Entity Type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:CYNTHIA
Last Name:DIAZ LUNA
Suffix:
Gender:F
Credentials:SLP INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 N CROSS LN APT 3
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78541-5641
Mailing Address - Country:US
Mailing Address - Phone:956-330-0099
Mailing Address - Fax:
Practice Address - Street 1:1240 US-83 BUS
Practice Address - Street 2:# A
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572
Practice Address - Country:US
Practice Address - Phone:956-600-7921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119874235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist