Healthcare Provider Details

I. General information

NPI: 1801034962
Provider Name (Legal Business Name): DIANA POSADAS LLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2009
Last Update Date: 01/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3514 N POWER RD STE 104
MESA AZ
85215-2907
US

IV. Provider business mailing address

3514 N POWER RD STE 104
MESA AZ
85215-2907
US

V. Phone/Fax

Practice location:
  • Phone: 480-516-3911
  • Fax:
Mailing address:
  • Phone: 480-516-3911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT03868P
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: