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General NPI Number Information
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NPI Number | 1861364762
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Entity Type | Individual
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Provider Name | MARTINA FRANCISCA DIAZ AGUILAR
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Gender | Female
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Dates
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Enumeration Date | 09/19/2025
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 1924 SOUTHWOOD DR
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City | LAKE CHARLES
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State | LA
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Zip | 70605-4131
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Country | US
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Telephone | 337-240-8162
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Fax |
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Provider Business Mailing Address
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Address Line | 1330 W MCNEESE ST APT 9307
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City | LAKE CHARLES
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State | LA
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Zip | 70605-4519
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | PLC10924
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License Number State | LA
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