MEDICARE: MANUEL ARMANDO DIAZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	13303	CA
2	106H00000X	Marriage & Family Therapist	137736	CA

General Provider Information

NPI Number	:	1710761572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANUEL ARMANDO DIAZ

Provider Business Mailing Address
First Line	:	3242 N MICA DR
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-9762
Country	:	US
Telephone Number	:	323-574-0203
Fax Number	:

Provider Business Practice Location Address
First Line	:	3242 N MICA DR
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-9762
Country	:	US
Telephone Number	:	323-574-0203
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2023
Last Update Date	:	08/22/2023

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Directions to “ MANUEL ARMANDO DIAZ ” Practice Location

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