Healthcare Provider Details

I. General information

NPI: 1780098954
Provider Name (Legal Business Name): DORSEY D. DIAZ, PSY.D., PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2014
Last Update Date: 03/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 E JOHN ST SUITE B
CARSON CITY NV
89706-3099
US

IV. Provider business mailing address

PO BOX 1205
CARSON CITY NV
89702-1205
US

V. Phone/Fax

Practice location:
  • Phone: 775-434-7132
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY0712
License Number StateNV

VIII. Authorized Official

Name: DR. DORSEY DIAZ
Title or Position: OWNER/PRESIDENT
Credential: PSY.D.
Phone: 775-430-2244