Carmen M Diaz Phd | |
2507 N Telshor Blvd Ste A4 Las Cruces NM 88011-8285 | |
(575) 522-5802 | |
Not Available |
Full Name | Carmen M Diaz Phd |
---|---|
Speciality | Psychologist |
Location | 2507 N Telshor Blvd, Las Cruces, New Mexico |
Authorized Official Name and Position | Karla Chavez (BUSINESS MANAGER) |
Authorized Official Contact | 5755225802 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Carmen M Diaz Phd 2507 N Telshor Blvd Ste A4 Las Cruces NM 88011-8285 Ph: (575) 522-5802 | Carmen M Diaz Phd 2507 N Telshor Blvd Ste A4 Las Cruces NM 88011-8285 Ph: (575) 522-5802 |
NPI Number | 1144638271 |
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Provider Enumeration Date | 08/01/2014 |
Last Update Date | 12/02/2014 |
Medicare PECOS PAC ID | 9234453101 |
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Medicare Enrollment ID | O20150123002117 |
Identifier | Type | State | Issuer |
---|---|---|---|
1144638271 | NPI | - | NPPES |
62125729 | Medicaid | NM | |
00679577 | Medicaid | NM |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
Provider Name | Carmen M Diaz |
---|---|
Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1962421834 PECOS PAC ID: 5698714194 Enrollment ID: I20050608001225 |
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