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General NPI Number Information
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NPI Number | 1538058268
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Entity Type | Individual
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Provider Name | GISELLE DIAZ REA ED.S
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Gender | Female
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Dates
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Enumeration Date | 06/30/2025
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 6161 FAIRMOUNT AVE APT 517
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City | SAN DIEGO
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State | CA
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Zip | 92120-3672
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Country | US
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Telephone | 847-809-1951
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Fax |
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Provider Business Mailing Address
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Address Line | 6161 FAIRMOUNT AVE APT 517
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City | SAN DIEGO
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State | CA
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Zip | 92120-3672
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Country | US
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Telephone | 847-809-1951
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 2677440
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | SP0000001211679
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 240234923
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License Number State | CA
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