Individual
IVANNA DIEGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
554 CHILTON ST, ELIZABETH, NJ 07208-1629
(908) 337-7820
Mailing address
554 CHILTON ST, ELIZABETH, NJ 07208-1629
(908) 337-7820
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
03/21/2022
Last updated
04/14/2022
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