Provider Demographics
NPI:1013771724
Name:DIAZ, WENDY MARBELLA (MS AND QASP-S)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:MARBELLA
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MS AND QASP-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 VALHALLA DR APT 69
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-3835
Mailing Address - Country:US
Mailing Address - Phone:626-316-2951
Mailing Address - Fax:
Practice Address - Street 1:1300 VALHALLA DR APT 69
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-3835
Practice Address - Country:US
Practice Address - Phone:626-316-2951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14359106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst