| NPI | 1326732173 |
|---|---|
| Former Name | JACQUELINE DANIELLE DIAZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 11065) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2023-06-05 |
| Last Update Date | 2025-08-06 |