Basic Information
| Provider Information | |||||||||
| NPI: | 1841321767 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIAZ | ||||||||
| FirstName: | VANESSA | ||||||||
| MiddleName: | I | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12806 SUNBURST ST | ||||||||
| Address2: | |||||||||
| City: | PACOIMA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913313341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188996960 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6931 VAN NUYS BLVD | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914053937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189016376 | ||||||||
| FaxNumber: | 8189016056 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 225400000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |
No ID Information.