Provider Demographics
NPI:1184404535
Name:DIAZ, SOLEDAD (ND)
Entity type:Individual
Prefix:
First Name:SOLEDAD
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4006 NE 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-1323
Mailing Address - Country:US
Mailing Address - Phone:972-624-9607
Mailing Address - Fax:
Practice Address - Street 1:415 NE BIRCH ST
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-2139
Practice Address - Country:US
Practice Address - Phone:360-834-2732
Practice Address - Fax:360-834-3063
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-03
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath