Provider Demographics
NPI:1922688134
Name:DIAZ, DIANA VANESSA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:VANESSA
Last Name:DIAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5731 W SLAUSON AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6982
Mailing Address - Country:US
Mailing Address - Phone:310-237-2236
Mailing Address - Fax:
Practice Address - Street 1:5731 W SLAUSON AVE STE 210
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6982
Practice Address - Country:US
Practice Address - Phone:310-237-2236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator