Healthcare Provider Details

I. General information

NPI: 1942089354
Provider Name (Legal Business Name): DIEGO HINOJOZA JR MS, LASAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 S NAPLES AVE
YUMA AZ
85364-5030
US

IV. Provider business mailing address

1640 BORO PL FL 4
MC LEAN VA
22102-3627
US

V. Phone/Fax

Practice location:
  • Phone: 928-261-8151
  • Fax:
Mailing address:
  • Phone: 845-769-8758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLASAC-15480
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: