Provider Demographics
NPI:1962797811
Name:QUIROGA-DIAZ, MICHELLE (MSW)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:QUIROGA-DIAZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1527 4TH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-2358
Mailing Address - Country:US
Mailing Address - Phone:310-394-9871
Mailing Address - Fax:310-451-9561
Practice Address - Street 1:1527 4TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2358
Practice Address - Country:US
Practice Address - Phone:310-394-9871
Practice Address - Fax:310-451-9561
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30082101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health