Provider Demographics
NPI:1730886490
Name:DIAZ, ROSA ELENA (MS, MFT-I)
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:ELENA
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MS, MFT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2298 W HORIZON RIDGE PKWY UNIT A
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2696
Mailing Address - Country:US
Mailing Address - Phone:702-483-0357
Mailing Address - Fax:
Practice Address - Street 1:2298 W HORIZON RIDGE PKWY UNIT A
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2696
Practice Address - Country:US
Practice Address - Phone:702-483-0357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI4212106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist