Provider Demographics
NPI:1881146728
Name:CAMBO DIAZ, SEBASTIAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:SEBASTIAN
Middle Name:
Last Name:CAMBO DIAZ
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14155 W MOUNTAIN VIEW BLVD APT 1049
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-4831
Mailing Address - Country:US
Mailing Address - Phone:787-453-6950
Mailing Address - Fax:
Practice Address - Street 1:14155 W MOUNTAIN VIEW BLVD APT 1049
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-4831
Practice Address - Country:US
Practice Address - Phone:787-453-6950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-26
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5647103TC0700X
AZ005574103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical