Healthcare Provider Details

I. General information

NPI: 1962421834
Provider Name (Legal Business Name): CARMEN MARGARITA DIAZ PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N CHURCH ST STE 200B
LAS CRUCES NM
88001-3515
US

IV. Provider business mailing address

201 N CHURCH ST STE 200B
LAS CRUCES NM
88001-3515
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-5802
  • Fax: 866-284-6720
Mailing address:
  • Phone: 575-522-5802
  • Fax: 866-284-6720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberNM0912
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number0912
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number0032
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: