Provider Information for 1124437579
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MARIEL DIAZ
Sex: Female
NPI: 1124437579
Last Updated: 2014-08-11
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1124437579 | ||||||||
| Enumeration Date | 2014-08-11 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 374 N COAST HIGHWAY 101 SUITE F-11 ENCINITAS, CA 92024-2542 United States Phone: 858-876-4401 | Fax: | ||||||||
| Primary Practice Address | 374 N COAST HIGHWAY 101 SUITE F-11 ENCINITAS, CA 92024-2542 United States Phone: 858-876-4401 | Fax: | ||||||||
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