Provider Demographics
NPI:1952684003
Name:DIAZ, MARIA TERESA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:TERESA
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 1:4012 MARINE VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92113-4333
Mailing Address - Country:US
Mailing Address - Phone:619-850-3932
Mailing Address - Fax:
Practice Address - Street 1:5005 TEXAS ST
Practice Address - Street 2:STE.203
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3721
Practice Address - Country:US
Practice Address - Phone:619-692-0727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker