Healthcare Provider Details

I. General information

NPI: 1538379649
Provider Name (Legal Business Name): NOEL J DIAZ PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 02/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 MAPLE AVE
LOS ANGELES CA
90013-1511
US

IV. Provider business mailing address

529 MAPLE AVE
LOS ANGELES CA
90013-1511
US

V. Phone/Fax

Practice location:
  • Phone: 213-430-6700
  • Fax: 213-895-6266
Mailing address:
  • Phone: 213-430-6700
  • Fax: 213-895-6266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY23569
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: