Provider Demographics
NPI:1114742475
Name:BACA, DIEGO ISAI
Entity type:Individual
Prefix:
First Name:DIEGO
Middle Name:ISAI
Last Name:BACA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2022 W HUMBOLDT DR
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-7446
Mailing Address - Country:US
Mailing Address - Phone:559-579-9949
Mailing Address - Fax:
Practice Address - Street 1:HURON MIDDLE SCHOOL, 16875 4TH ST
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:CA
Practice Address - Zip Code:93234
Practice Address - Country:US
Practice Address - Phone:559-579-9949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool