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General NPI Number Information
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NPI Number | 1205562402
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Entity Type | Individual
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Provider Name | ROSSANA DIAZ LE, CMT, MMP
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Gender | Female
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Dates
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Enumeration Date | 07/29/2022
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Last Update Date | 07/29/2022
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Provider Practice Location Address
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Address Line | 222 N MOUNTAIN AVE STE 210A
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City | UPLAND
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State | CA
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Zip | 91786-5714
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Country | US
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Telephone | 833-473-2233
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Fax |
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Provider Business Mailing Address
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Address Line | 1295 E 9TH ST APT 10
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City | UPLAND
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State | CA
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Zip | 91786-8108
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Country | US
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Telephone | 626-905-6330
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 88703
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License Number State | CA
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