Individual
ITZEL DIEGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1121 JUDSON RD STE 140, LONGVIEW, TX 75601-5119
(903) 309-0702
Mailing address
1121 JUDSON RD STE 140, LONGVIEW, TX 75601-5119
(903) 309-0702
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
110207
TX
Other
Enumeration date
02/29/2024
Last updated
02/29/2024
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