Provider Demographics
NPI:1871957084
Name:DIAZ, JOCELYN (LMT)
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 CENTRE ST
Mailing Address - Street 2:APT 230
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-1651
Mailing Address - Country:US
Mailing Address - Phone:617-595-3511
Mailing Address - Fax:
Practice Address - Street 1:270 CENTRE ST
Practice Address - Street 2:APT 230
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-1651
Practice Address - Country:US
Practice Address - Phone:617-595-3511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12374225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist