Basic Information
| Provider Information | |||||||||
| NPI: | 1306875265 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DIAZ | ||||||||
| FirstName: | RICK | ||||||||
| MiddleName: | DION | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LISAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3250A E 40TH ST | ||||||||
| Address2: | |||||||||
| City: | YUMA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9283410335 | ||||||||
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| Practice Location | |||||||||
| Address1: | 106 E 1ST ST | ||||||||
| Address2: | |||||||||
| City: | YUMA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853641450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9283410335 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | LISAC-10494 | AZ | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 928335 | 01 | AZ | AHCCCS # | OTHER |