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General NPI Number Information
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NPI Number | 1821585308
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Entity Type | Individual
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Provider Name | DAVID ALONZO DIAZ
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Gender | Male
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Dates
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Enumeration Date | 04/19/2018
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Last Update Date | 01/18/2024
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Provider Practice Location Address
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Address Line | 1414 N CALIFORNIA ST
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City | STOCKTON
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State | CA
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Zip | 95202-1515
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Country | US
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Telephone | 209-468-8651
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 W BRIGGSMORE AVE STE I
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City | MODESTO
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State | CA
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Zip | 95350-3839
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Country | US
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Telephone | 209-526-1476
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Fax | 209-526-0908
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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 | 129095
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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