Basic Information
| Provider Information | |||||||||
| NPI: | 1962797811 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | QUIROGA-DIAZ | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1527 4TH ST | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904012358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103949871 | ||||||||
| FaxNumber: | 3104519561 | ||||||||
| Practice Location | |||||||||
| Address1: | 1527 4TH ST | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904012358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103949871 | ||||||||
| FaxNumber: | 3104519561 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2011 | ||||||||
| LastUpdateDate: | 06/17/2011 | ||||||||
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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 | 101YM0800X | 30082 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.