Active NPI
Vanessa Diaz
- Psychiatric/Mental Health Nurse Practitioner
- Anaheim, CA
National Provider Identifier
1093408775
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner
- License
- 95025131
- Practice address
- 1212 N Boden Dr
Anaheim, CA 92805-1230 - Phone
- (714) 713-8170
- NPI assigned
- May 30, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 95025131 | CA | Primary |
Addresses
Primary practice location
1212 N Boden Dr
Anaheim, CA 92805-1230
Mailing address
1212 N Boden Dr
Anaheim, CA 92805-1230
Phone (714) 713-8170
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240828004564 | CA | Practitioner - Nurse Practitioner | 5395284822 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1685404800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705449600000",
"number": "1093408775",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1212 N BODEN DR",
"city": "ANAHEIM",
"state": "CA",
"postal_code": "928051230",
"telephone_number": "714-713-8170"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1212 N BODEN DR",
"city": "ANAHEIM",
"state": "CA",
"postal_code": "928051230",
"telephone_number": "714-713-8170"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIAZ",
"first_name": "VANESSA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-05-30",
"last_updated": "2024-01-17",
"certification_date": "2024-01-17",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0808X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": "CA",
"license": "95025131",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Anaheim, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.