Provider Demographics
NPI:1780557660
Name:DIAZ, GABRIELLA CHRISTINA (PMHNP)
Entity type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:CHRISTINA
Last Name:DIAZ
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 ILCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-4433
Mailing Address - Country:US
Mailing Address - Phone:615-337-7071
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:630 TOWNE CENTER DR
Practice Address - Street 2:
Practice Address - City:JOPPA
Practice Address - State:MD
Practice Address - Zip Code:21085-4440
Practice Address - Country:US
Practice Address - Phone:410-510-7099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-26
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR225958363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health