Provider Demographics
NPI:1942737044
Name:DIAZ, DANIELLE YOLANDA (ATC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:YOLANDA
Last Name:DIAZ
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2815 4TH ST NE APT 2
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-1252
Mailing Address - Country:US
Mailing Address - Phone:805-625-4201
Mailing Address - Fax:
Practice Address - Street 1:2400 6TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20059
Practice Address - Country:US
Practice Address - Phone:805-625-4201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-19
Last Update Date:2018-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
20000244142255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer