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General NPI Number Information
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NPI Number | 1073983177
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Entity Type | Individual
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Provider Name | HORTENCIA DIAZ
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Gender | Female
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Dates
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Enumeration Date | 10/01/2015
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Last Update Date | 07/13/2018
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Provider Practice Location Address
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Address Line | 73550 ALESSANDRO DR STE 200
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City | PALM DESERT
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State | CA
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Zip | 92260
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Country | US
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Telephone | 760-834-9008
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Fax |
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Provider Business Mailing Address
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Address Line | 73550 ALESSANDRO DR STE 200
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City | PALM DESERT
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State | CA
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Zip | 92260-3613
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Country | US
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Telephone | 760-834-9008
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 103290
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License Number State | CA
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