Basic Information
| Provider Information | |||||||||
| NPI: | 1477037471 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIAZ | ||||||||
| FirstName: | LISA | ||||||||
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| Credential: | RRT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 29969 MULEDEER LN | ||||||||
| Address2: | |||||||||
| City: | CASTAIC | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913844503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7605493446 | ||||||||
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| Practice Location | |||||||||
| Address1: | 13651 CANTARA ST | ||||||||
| Address2: | |||||||||
| City: | PANORAMA CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183752000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2018 | ||||||||
| LastUpdateDate: | 09/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 227900000X | 26739 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered |
No ID Information.