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General NPI Number Information
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NPI Number | 1154219103
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Entity Type | Individual
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Provider Name | NATHANIEL DIAZ
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Gender | Male
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Dates
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Enumeration Date | 06/26/2025
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 1605 GEORGE DIETER DR STE 308
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City | EL PASO
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State | TX
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Zip | 79936-5686
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Country | US
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Telephone | 915-257-1093
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 SAUL KLEINFELD DR APT 706
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City | EL PASO
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State | TX
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Zip | 79936-3766
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Country | US
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Telephone | 610-823-3489
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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