Provider Demographics
NPI:1992575278
Name:DIAZ, ANGIE
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANGELICA
Other - Middle Name:G
Other - Last Name:DIAZ-TREMILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8350 S PIONEER WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-4675
Mailing Address - Country:US
Mailing Address - Phone:702-782-2693
Mailing Address - Fax:
Practice Address - Street 1:8350 S PIONEER WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-4675
Practice Address - Country:US
Practice Address - Phone:702-782-2693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT3104106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician