Provider Demographics
NPI:1285428961
Name:DIAZ DE LA CUESTA, NOAH JAKE
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:JAKE
Last Name:DIAZ DE LA CUESTA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 RECREATION LN
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-1169
Mailing Address - Country:US
Mailing Address - Phone:440-934-9622
Mailing Address - Fax:
Practice Address - Street 1:2010 RECREATION LN
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-1169
Practice Address - Country:US
Practice Address - Phone:440-934-9622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach