Healthcare Provider Details

I. General information

NPI: 1902022742
Provider Name (Legal Business Name): ISHMAEL HUGGINS-DIAZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 E LAKE AVE
WATSONVILLE CA
95076-4717
US

IV. Provider business mailing address

241 E LAKE AVE
WATSONVILLE CA
95076-4717
US

V. Phone/Fax

Practice location:
  • Phone: 831-728-2227
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: