Provider Demographics
NPI:1184188112
Name:DIAZ, DAISY
Entity type:Individual
Prefix:
First Name:DAISY
Middle Name:
Last Name:DIAZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 S DAWSON ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-2067
Mailing Address - Country:US
Mailing Address - Phone:206-519-4920
Mailing Address - Fax:
Practice Address - Street 1:6840 FORT DENT WAY STE 350
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-8512
Practice Address - Country:US
Practice Address - Phone:253-850-2500
Practice Address - Fax:253-850-2530
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG61226332106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1184188112Medicaid