Healthcare Provider Details

I. General information

NPI: 1972412948
Provider Name (Legal Business Name): ANAHI DIAZ ENRIQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16165 N 83RD AVE STE 200
PEORIA AZ
85382-5816
US

IV. Provider business mailing address

257 CAVANESS AVE STE 200
WICKENBURG AZ
85390-1409
US

V. Phone/Fax

Practice location:
  • Phone: 602-526-5321
  • Fax: --
Mailing address:
  • Phone: 602-526-5321
  • Fax: --

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLIAC-155427
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: