Healthcare Provider Details

I. General information

NPI: 1700021318
Provider Name (Legal Business Name): MR. ROBERT RICHARD DIAZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2008
Last Update Date: 12/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 LONG BEACH BLVD
LONG BEACH CA
90806-5501
US

IV. Provider business mailing address

1975 LONG BEACH BLVD
LONG BEACH CA
90806-5501
US

V. Phone/Fax

Practice location:
  • Phone: 562-599-9280
  • Fax: 562-599-3934
Mailing address:
  • Phone: 562-599-9280
  • Fax: 562-599-3934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: