Active NPI
Nellie I Diaz Diaz, PWS
- Peer Specialist
- Salem, OR
National Provider Identifier
1316720709
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- THW000109409
- Practice address
- 1011 Commercial St NE
Salem, OR 97301-1049 - Phone
- (503) 983-9900
- NPI assigned
- Aug 17, 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 |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | THW000109409 | OR | Primary |
Addresses
Primary practice location
1011 Commercial St NE
Salem, OR 97301-1049
Mailing address
3652 Sunnyview Rd NE
Salem, OR 97305-1016
Phone (503) 302-5650
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| THW000109409 | OR | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1692230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692230400000",
"number": "1316720709",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3652 SUNNYVIEW RD NE",
"city": "SALEM",
"state": "OR",
"postal_code": "973051016",
"telephone_number": "503-302-5650"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1011 COMMERCIAL ST NE",
"city": "SALEM",
"state": "OR",
"postal_code": "973011049",
"telephone_number": "503-983-9900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIAZ DIAZ",
"first_name": "NELLIE",
"middle_name": "I",
"credential": "PWS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-08-17",
"last_updated": "2023-08-17",
"certification_date": "2023-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "OR",
"license": "THW000109409",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salem, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.