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General NPI Number Information
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NPI Number | 1073497988
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Entity Type | Individual
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Provider Name | VANESSA DIAZ M.ED, M.ED
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Gender | Female
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Dates
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Enumeration Date | 08/04/2025
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 400 E RANDOLPH ST APT 808
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City | CHICAGO
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State | IL
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Zip | 60601-7101
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Country | US
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Telephone | 872-800-2895
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Fax |
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Provider Business Mailing Address
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Address Line | 400 E RANDOLPH ST APT 808
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City | CHICAGO
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State | IL
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Zip | 60601-7101
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Country | US
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Telephone | 872-800-2895
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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