Healthcare Provider Details

I. General information

NPI: 1609115302
Provider Name (Legal Business Name): ROSALIE CHRISTINE DIAZ PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2013
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120-16555 FRASER HWY
SURREY BC
V4N OE9
CA

IV. Provider business mailing address

14819 59A AVENUE
SURREY BC
V3S 2W6
CA

V. Phone/Fax

Practice location:
  • Phone: 604-575-2325
  • Fax:
Mailing address:
  • Phone: 778-960-6762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: