Basic Information
| Provider Information | |||||||||
| NPI: | 1316447154 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIAZ | ||||||||
| FirstName: | MARINA | ||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16835 DEER CREEK DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | SPRING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773794895 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2816641990 | ||||||||
| FaxNumber: | 2816641991 | ||||||||
| Practice Location | |||||||||
| Address1: | 6051 FM 3009 STE 215 | ||||||||
| Address2: | |||||||||
| City: | SCHERTZ | ||||||||
| State: | TX | ||||||||
| PostalCode: | 781543433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8304206200 | ||||||||
| FaxNumber: | 8304206210 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2018 | ||||||||
| LastUpdateDate: | 04/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | N | 103K00000X | 4070 | TX | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.