Provider Demographics
NPI:1972864296
Name:DIAZ, JANETTE
Entity Type:Individual
Prefix:
First Name:JANETTE
Middle Name:
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 1:2050 S BLOSSER RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-7310
Mailing Address - Country:US
Mailing Address - Phone:805-361-8030
Mailing Address - Fax:805-361-8097
Practice Address - Street 1:4723 W MAIN ST STE H
Practice Address - Street 2:
Practice Address - City:GUADALUPE
Practice Address - State:CA
Practice Address - Zip Code:93434-1787
Practice Address - Country:US
Practice Address - Phone:805-343-5577
Practice Address - Fax:805-343-5578
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-04
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical