Healthcare Provider Details

I. General information

NPI: 1194001958
Provider Name (Legal Business Name): ANNA MARIA DIAZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2011
Last Update Date: 01/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 FLORIDA AVE
MODESTO CA
95350-4437
US

IV. Provider business mailing address

737 W CHILDS AVE
MERCED CA
95341-6805
US

V. Phone/Fax

Practice location:
  • Phone: 209-574-1365
  • Fax: 209-574-1372
Mailing address:
  • Phone: 209-384-6493
  • Fax: 209-383-1296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number63380
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: