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General NPI Number Information
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NPI Number | 1396914248
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Entity Type | Individual
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Provider Name | HORACIO DIAZ
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Gender | Male
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Dates
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Enumeration Date | 02/25/2008
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Last Update Date | 05/23/2016
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Provider Practice Location Address
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Address Line | 5150 E PCH STE 100
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City | LONG BEACH
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State | CA
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Zip | 90804-3394
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Country | US
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Telephone | 562-490-7600
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Fax | 562-490-7601
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Provider Business Mailing Address
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Address Line | 3064 S ADRIENNE DR
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City | WEST COVINA
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State | CA
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Zip | 91792-2103
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Country | US
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Telephone | 626-965-0708
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Fax | 562-490-7601
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | IMF82081
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License Number State | CA
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