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General NPI Number Information
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NPI Number | 1174364103
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Entity Type | Organization
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Legal Business Name | DIAZ PSYCHIATRY, LLC
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Dates
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Enumeration Date | 06/04/2024
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 90 WEBSTER ST APT 1
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City | EAST BOSTON
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State | MA
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Zip | 02128-2978
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Country | US
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Telephone | 781-519-4829
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Fax |
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Provider Business Mailing Address
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Address Line | 2 NEPTUNE RD # 147
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City | EAST BOSTON
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State | MA
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Zip | 02128-1457
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SANDRA DIAZ
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Credential | DO
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Telephone | 972-679-6376
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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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 | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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