Provider Demographics
NPI:1073497988
Name:DIAZ, VANESSA (MED, MED)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MED, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E RANDOLPH ST APT 808
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7101
Mailing Address - Country:US
Mailing Address - Phone:872-800-2895
Mailing Address - Fax:
Practice Address - Street 1:400 E RANDOLPH ST APT 808
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7101
Practice Address - Country:US
Practice Address - Phone:872-800-2895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency