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Individual

DENISE DIAZ

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
20377 OLD SCENIC HWY, ZACHARY, LA 70791-7366
(225) 371-6475
Mailing address
PO BOX 15151, BATON ROUGE, LA 70895-5151
(225) 371-6475

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
LA7655
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
46-4557270
LLC
Enumeration date
04/17/2014
Last updated
04/17/2014
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