Provider Demographics
NPI:1023770112
Name:DIAZ, MARIA G (MT)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:G
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:G
Other - Last Name:DIAZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MT
Mailing Address - Street 1:33550 WILLOW HAVEN LN UNIT 105
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-3480
Mailing Address - Country:US
Mailing Address - Phone:951-331-5716
Mailing Address - Fax:
Practice Address - Street 1:33550 WILLOW HAVEN LN UNIT 105
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-3480
Practice Address - Country:US
Practice Address - Phone:951-331-5716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87109225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist