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General NPI Number Information
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NPI Number | 1013445352
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Entity Type | Organization
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Legal Business Name | TARA DIAZ WELLNESS
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Dates
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Enumeration Date | 05/31/2017
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Last Update Date | 07/11/2019
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Provider Practice Location Address
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Address Line | 519 MAIN ST
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City | EL SEGUNDO
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State | CA
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Zip | 90245-3006
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Country | US
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Telephone | 424-258-0738
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Fax |
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Provider Business Mailing Address
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Address Line | 519 MAIN ST
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City | EL SEGUNDO
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State | CA
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Zip | 90245-3006
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Country | US
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Telephone | 424-258-0738
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TARA SCHACHTER-DIAZ
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Credential | LAC
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Telephone | 424-258-0738
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 15635
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License Number State | CA
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