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NPI Code Detail

MEDICARE: DESYRE DIAZ PSYD

MEDICARE: DESYRE DIAZ PSYD
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
1103T00000XPsychologistAZ

General Provider Information

NPI Number : 1801465265
Entity Type Code : Individual
Provider Name (Legal Business Name) : DESYRE DIAZ PSYD
Provider Business Mailing Address
First Line : 4621 W WAGONER RD
Second Line :
City : GLENDALE
State : AZ
Zip : 85308-1526
Country : US
Telephone Number : 480-371-8429
Fax Number :
Provider Business Practice Location Address
First Line : 1600 W 24TH ST
Second Line :
City : PUEBLO
State : CO
Zip : 81003-1411
Country : US
Telephone Number : 719-252-2871
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2021
Last Update Date : 04/15/2026

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