Healthcare Provider Details

I. General information

NPI: 1831907906
Provider Name (Legal Business Name): MARIBEL DIAZ ND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2024
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 N DEARBORN ST STE 800
CHICAGO IL
60654-3874
US

IV. Provider business mailing address

2020 W 23RD ST APT 2
CHICAGO IL
60608-4106
US

V. Phone/Fax

Practice location:
  • Phone: 312-335-9330
  • Fax:
Mailing address:
  • Phone: 208-969-1128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: