Most Relevant Information
Provider Data
| NPI Number: | 1003480666 |
| Provider Name: | NINA MARIE DIAZ SLPA |
| Entity Type: | Individual |
| Taxonomy Code: | 2355S0801X |
| Specialty: | Specialist/Technologist |
| License Number: | SPA5402 |
Most Important Dates
| Enumeration Date: | 05/18/2021 |
| Last Updated: | 05/18/2021 |
Provider Practice Location
611 N BRAND BLVD # 100
GLENDALE
CA
912031221
Practice Location Phone/Fax
| Phone: | 7472862600 |
| Fax: |
Provider Mailing Location
6245 CAHUENGA BLVD APT 5
NORTH HOLLYWOOD
CA
916063900
Provider Mailing Phone/Fax
| Phone: | 8183788158 |
| Fax: |