Provider Demographics
NPI:1063128429
Name:DIAZ, EDUARDO
Entity type:Individual
Prefix:
First Name:EDUARDO
Middle Name:
Last Name:DIAZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:EDUARDO
Other - Middle Name:
Other - Last Name:DIAZ-SANTIAGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6655 W SAHARA AVE STE C203
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-0850
Mailing Address - Country:US
Mailing Address - Phone:702-900-2784
Mailing Address - Fax:
Practice Address - Street 1:6655 W SAHARA AVE STE C203
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-0850
Practice Address - Country:US
Practice Address - Phone:702-900-2784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI4196106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist