Individual
SELENA MARIE DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
15350 NORDHOFF ST STE A, NORTH HILLS, CA 91343-2234
(818) 672-8228
Mailing address
13837 RUNNYMEDE ST, VAN NUYS, CA 91405-1518
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
67509
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
67509
—
CA
Enumeration date
10/07/2016
Last updated
10/07/2016
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