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General NPI Number Information
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NPI Number | 1831709096
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Entity Type | Individual
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Provider Name | EVELYN DIAZ
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Gender | Female
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Dates
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Enumeration Date | 08/03/2020
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Last Update Date | 08/03/2020
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Provider Practice Location Address
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Address Line | 1940 N PENNSYLVANIA ST
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City | DENVER
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State | CO
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Zip | 80203-1340
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Country | US
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Telephone | 319-961-9869
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Fax |
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Provider Business Mailing Address
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Address Line | 3237 W AVONDALE DR
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City | DENVER
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State | CO
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Zip | 80204-2207
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Country | US
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Telephone | 916-968-3805
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT0023169
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License Number State | CO
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