Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 95015631 | CA |
NPI | 1164049847 |
---|---|
Provider Name | Mrs. Ashley Ann Diaz |
First Address | Folsom, CA 95630-6695 |
Second Address | Sacramento, CA 95817-2201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2020 |
Last Update Date | 30/11/2020 |