Provider Demographics
NPI:1023486438
Name:DIAZ ERAZO, SUCELLY MELISSA
Entity type:Individual
Prefix:
First Name:SUCELLY
Middle Name:MELISSA
Last Name:DIAZ ERAZO
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 1:501 EL RANCHO DR SPC 88
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-4117
Mailing Address - Country:US
Mailing Address - Phone:775-223-6530
Mailing Address - Fax:
Practice Address - Street 1:501 EL RANCHO DR SPC 88
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-4117
Practice Address - Country:US
Practice Address - Phone:775-223-6530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-02
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)