Provider Demographics
NPI:1316001571
Name:DIAZ, SALVADOR (BA)
Entity type:Individual
Prefix:
First Name:SALVADOR
Middle Name:
Last Name:DIAZ
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FORDHAM HILL OVAL APT 17C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-8004
Mailing Address - Country:US
Mailing Address - Phone:718-960-0412
Mailing Address - Fax:718-933-8208
Practice Address - Street 1:1 FORDHAM HILL OVAL APT 17C
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-8004
Practice Address - Country:US
Practice Address - Phone:718-960-0412
Practice Address - Fax:718-933-8208
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health