Provider Demographics
NPI:1346882800
Name:DIAZ, LETICIA MARAVILLA
Entity type:Individual
Prefix:MRS
First Name:LETICIA
Middle Name:MARAVILLA
Last Name:DIAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7471 N FRESNO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2457
Mailing Address - Country:US
Mailing Address - Phone:559-436-4500
Mailing Address - Fax:559-261-1526
Practice Address - Street 1:1853 LANDER AVE
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-6240
Practice Address - Country:US
Practice Address - Phone:209-656-1617
Practice Address - Fax:209-656-1626
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-16
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant