Provider Demographics
NPI:1912176389
Name:DIAZ, VIOLETA A (LPN)
Entity Type:Individual
Prefix:MS
First Name:VIOLETA
Middle Name:A
Last Name:DIAZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:658 ROSEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-6308
Mailing Address - Country:US
Mailing Address - Phone:347-275-6708
Mailing Address - Fax:
Practice Address - Street 1:781 EAST 142ND STREET
Practice Address - Street 2:SOUTH BRONX MENTAL HEALTH COUNCIL INC
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454-1724
Practice Address - Country:US
Practice Address - Phone:718-993-1400
Practice Address - Fax:718-993-0647
Is Sole Proprietor?:No
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1812967164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse