Provider Demographics
NPI:1972365179
Name:DIAZ, VANESSA M (MS, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:M
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MS, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 W LOCUST CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-1018
Mailing Address - Country:US
Mailing Address - Phone:520-576-7529
Mailing Address - Fax:
Practice Address - Street 1:641 W LOCUST CT
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-1018
Practice Address - Country:US
Practice Address - Phone:520-576-7529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COL-314470174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN