Healthcare Provider Details

I. General information

NPI: 1346171337
Provider Name (Legal Business Name): NATHALIA DIAZ DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3790 COON RAPIDS BLVD NW
COON RAPIDS MN
55433-2629
US

IV. Provider business mailing address

13102 ISETTA CIR NE
BLAINE MN
55449-7563
US

V. Phone/Fax

Practice location:
  • Phone: 763-341-9285
  • Fax:
Mailing address:
  • Phone: 403-669-7788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD15455
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: