Healthcare Provider Details

I. General information

NPI: 1184404535
Provider Name (Legal Business Name): SOLEDAD DIAZ ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2023
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 NE BIRCH ST
CAMAS WA
98607-2139
US

IV. Provider business mailing address

4006 NE 15TH AVE
PORTLAND OR
97212-1323
US

V. Phone/Fax

Practice location:
  • Phone: 360-834-2732
  • Fax: 360-834-3063
Mailing address:
  • Phone: 972-624-9607
  • 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: