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General NPI Number Information
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NPI Number | 1235057571
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Entity Type | Individual
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Provider Name | MS. BIANCA LYZETTE DIAZ
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Gender | Female
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Dates
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Enumeration Date | 07/06/2026
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Last Update Date | 07/06/2026
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Provider Practice Location Address
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Address Line | 1609 N PRINCE ST
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City | CLOVIS
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State | NM
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Zip | 88101-4850
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Country | US
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Telephone | 956-720-1901
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Fax |
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Provider Business Mailing Address
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Address Line | 4233 LEW WALLACE DR
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City | CLOVIS
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State | NM
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Zip | 88101-2539
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Country | US
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Telephone | 956-720-1901
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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 | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number | PTA1493
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License Number State | NM
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