Basic Information
| Provider Information | |||||||||
| NPI: | 1336654979 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DIAZ | ||||||||
| FirstName: | AIDEE | ||||||||
| MiddleName: | MARIBEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11741 TELEGRAPH RD STE A | ||||||||
| Address2: | |||||||||
| City: | SANTA FE SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906706829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628010318 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11741 TELEGRAPH RD STE A | ||||||||
| Address2: | |||||||||
| City: | SANTA FE SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906706829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628010318 | ||||||||
| FaxNumber: | 5629493642 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2017 | ||||||||
| LastUpdateDate: | 12/05/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | VN692190 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.