Healthcare Provider Details

I. General information

NPI: 1205257482
Provider Name (Legal Business Name): RACHEL DIAZ MSN,RN,CCM,CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2013
Last Update Date: 09/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S EDWIN C MOSES BLVD. - 4TH FLOOR NW BUILDING SAMARITAN BEHAVIORAL HEALTH, INC.
DAYTON OH
45417-3424
US

IV. Provider business mailing address

601 S EDWIN C MOSES BLVD. - 4TH FLOOR NW BUILDING SAMARITAN BEHAVIORAL HEALTH, INC.
DAYTON OH
45417-3424
US

V. Phone/Fax

Practice location:
  • Phone: 937-734-8333
  • Fax: 937-734-4343
Mailing address:
  • Phone: 937-734-8333
  • Fax: 937-734-4343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberCOA.15091.NP
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCOA.15091.NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: