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General NPI Number Information
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NPI Number | 1821499062
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Entity Type | Individual
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Provider Name | KYRENE DIAZ
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Gender | Female
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Dates
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Enumeration Date | 09/08/2014
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Last Update Date | 11/28/2023
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Provider Practice Location Address
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Address Line | 1401 21ST ST STE R
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City | SACRAMENTO
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State | CA
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Zip | 95811-5226
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Country | US
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Telephone | 818-275-1777
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Fax |
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Provider Business Mailing Address
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Address Line | 23638 NEWHALL AVE STE 6
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City | NEWHALL
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State | CA
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Zip | 91321-4234
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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 |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 32134
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License Number State | CA
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