MEDICARE: VANESSA 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	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1942601471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA DIAZ

Provider Business Mailing Address
First Line	:	209 WILLOW ST
Second Line	:
City	:	PORT READING
State	:	NJ
Zip	:	07064-1226
Country	:	US
Telephone Number	:	908-380-6425
Fax Number	:

Provider Business Practice Location Address
First Line	:	209 WILLOW ST
Second Line	:
City	:	PORT READING
State	:	NJ
Zip	:	07064-1226
Country	:	US
Telephone Number	:	908-380-6425
Fax Number	:

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

Provider Enumeration Date	:	09/16/2014
Last Update Date	:	09/16/2014

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Directions to “ VANESSA DIAZ ” Practice Location

Language	Start Address	Practice Location

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