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NPI Code Detail

MEDICARE: MARTHA ALICIA DIAZ

MEDICARE:   MARTHA ALICIA DIAZ
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1167G00000XLicensed Psychiatric TechnicianCA

General Provider Information

NPI Number : 1073135703
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARTHA ALICIA DIAZ
Provider Business Mailing Address
First Line : 23959 COUGAS CREEK RD
Second Line :
City : DIAMOND BAR
State : CA
Zip : 91765-1104
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 16756 CHINO CORONA RD
Second Line :
City : EASTVALE
State : CA
Zip : 92880-9508
Country : US
Telephone Number : 909-597-1771
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2020
Last Update Date : 05/15/2020

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Directions to “ MARTHA ALICIA DIAZ ” Practice Location

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