Healthcare Provider Details

I. General information

NPI: 1891181087
Provider Name (Legal Business Name): ANGELA DIAZ B.S. SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 04/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9604 CAMINITO TIZONA
SAN DIEGO CA
92126-4103
US

IV. Provider business mailing address

9604 CAMINITO TIZONA
SAN DIEGO CA
92126-4103
US

V. Phone/Fax

Practice location:
  • Phone: 619-820-0187
  • Fax:
Mailing address:
  • Phone: 619-820-0187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number2981
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: