Provider Demographics
NPI:1457994303
Name:DIAZ, ANTHONY BRYAN
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:BRYAN
Last Name:DIAZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N BRAND BLVD OFC 233
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-3588
Mailing Address - Country:US
Mailing Address - Phone:818-722-1770
Mailing Address - Fax:855-568-2494
Practice Address - Street 1:201 N BRAND BLVD OFC 233
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-3588
Practice Address - Country:US
Practice Address - Phone:818-722-1770
Practice Address - Fax:855-568-2494
Is Sole Proprietor?:No
Enumeration Date:2019-10-23
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator