Healthcare Provider Details

I. General information

NPI: 1104734698
Provider Name (Legal Business Name): BRITTANY MARIE DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 N STATE ST STE D
UKIAH CA
95482-4298
US

IV. Provider business mailing address

665 N STATE ST STE D
UKIAH CA
95482-4298
US

V. Phone/Fax

Practice location:
  • Phone: 707-391-9200
  • Fax:
Mailing address:
  • Phone: 707-391-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number9939
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: