Provider Demographics
NPI:1386341402
Name:DIAZ, ELIZABETH RANEE MODESTA (RT(R) (CT) ARRT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:RANEE MODESTA
Last Name:DIAZ
Suffix:
Gender:F
Credentials:RT(R) (CT) ARRT
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Other - Last Name:
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Mailing Address - Street 1:3717 BAUER DR
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-2106
Mailing Address - Country:US
Mailing Address - Phone:989-980-2329
Mailing Address - Fax:
Practice Address - Street 1:1500 WEISS ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-5251
Practice Address - Country:US
Practice Address - Phone:989-497-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist