Individual
MARISSA DIAZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
22080 LA HWY 20, VACHERIE, LA 70090
(225) 265-3061
(225) 265-3062
Mailing address
PO BOX 69, VACHERIE, LA 70090-0069
(225) 265-3061
(225) 265-3062
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
887
LA
Other
Enumeration date
05/26/2015
Last updated
05/26/2015
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