Healthcare Provider Details

I. General information

NPI: 1659822112
Provider Name (Legal Business Name): MINDI DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 10/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 BAYONET CIR
MARINA CA
93933-4600
US

IV. Provider business mailing address

1009 BISON WAY
SALINAS CA
93905-4447
US

V. Phone/Fax

Practice location:
  • Phone: 831-384-7251
  • Fax:
Mailing address:
  • Phone: 831-235-7648
  • Fax:

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: