Healthcare Provider Details

I. General information

NPI: 1790552586
Provider Name (Legal Business Name): GENIA TOWNER-DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 CONSTITUTION BLVD STE 202
SALINAS CA
93906-3127
US

IV. Provider business mailing address

1441 CONSTITUTION BLVD STE 202
SALINAS CA
93906-3127
US

V. Phone/Fax

Practice location:
  • Phone: 831-769-0552
  • Fax:
Mailing address:
  • Phone: 831-769-0552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number207040
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: