MEDICARE: MR. ROBERT EDWARD DIAZ LCSW

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	1041C0700X	Clinical Social Worker	LCS23162	CA

General Provider Information

NPI Number	:	1952567745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT EDWARD DIAZ LCSW

Provider Business Mailing Address
First Line	:	1250 E. WALNUT ST
Second Line	:	SUITE 110
City	:	PASADENA
State	:	CA
Zip	:	91106
Country	:	US
Telephone Number	:	626-376-3328
Fax Number	:

Provider Business Practice Location Address
First Line	:	1250 E WALNUT ST STE 110
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91106-1877
Country	:	US
Telephone Number	:	626-376-3328
Fax Number	:

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

Provider Enumeration Date	:	08/01/2008
Last Update Date	:	12/10/2021

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