Provider Demographics
NPI:1205257482
Name:DIAZ, RACHEL (MSN,RN,CCM,CPNP)
Entity type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MSN,RN,CCM,CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S EDWIN C MOSES BLVD. - 4TH FLOOR NW BUILDING
Mailing Address - Street 2:SAMARITAN BEHAVIORAL HEALTH, INC.
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-3424
Mailing Address - Country:US
Mailing Address - Phone:937-734-8333
Mailing Address - Fax:937-734-4343
Practice Address - Street 1:601 S EDWIN C MOSES BLVD. - 4TH FLOOR NW BUILDING
Practice Address - Street 2:SAMARITAN BEHAVIORAL HEALTH, INC.
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-3424
Practice Address - Country:US
Practice Address - Phone:937-734-8333
Practice Address - Fax:937-734-4343
Is Sole Proprietor?:No
Enumeration Date:2013-12-14
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.15091.NP363LP0200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH31-600064Medicaid