Provider Demographics
NPI:1184493835
Name:DIAZ, ROSA CARMINA (NP)
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:CARMINA
Last Name:DIAZ
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:ROSA
Other - Middle Name:CARMINA
Other - Last Name:DIAZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ROSA CARMINA DIAZ RN
Mailing Address - Street 1:3580 WILSHIRE BLVD STE 2000
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2533
Mailing Address - Country:US
Mailing Address - Phone:213-381-1250
Mailing Address - Fax:213-383-4803
Practice Address - Street 1:3580 WILSHIRE BLVD STE 2000
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2533
Practice Address - Country:US
Practice Address - Phone:212-381-1250
Practice Address - Fax:213-383-4803
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-21
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA951071502084P0802X, 390200000X
CA95033456363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program