Provider Demographics
NPI:1881460301
Name:DIAZ, CARMEN RENE'
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:RENE'
Last Name:DIAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41990 COOK ST STE 801A
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-6103
Mailing Address - Country:US
Mailing Address - Phone:442-666-3217
Mailing Address - Fax:760-616-7035
Practice Address - Street 1:41990 COOK ST STE 801A
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-6103
Practice Address - Country:US
Practice Address - Phone:442-666-3217
Practice Address - Fax:760-616-7035
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-27
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program