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NPI Code Detail

MEDICARE: VANESSA LIZBETH DIAZ

MEDICARE: VANESSA LIZBETH 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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1295200244
Entity Type Code : Individual
Provider Name (Legal Business Name) : VANESSA LIZBETH DIAZ
Provider Business Mailing Address
First Line : 9167 W FLAMINGO RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89147-6472
Country : US
Telephone Number : 702-565-1894
Fax Number :
Provider Business Practice Location Address
First Line : 9167 W FLAMINGO RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89147-6472
Country : US
Telephone Number : 702-565-1894
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2018
Last Update Date : 10/05/2018

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Directions to “ VANESSA LIZBETH DIAZ ” Practice Location

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