MEDICARE: JENNIFER DIAZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician
2	106E00000X	Assistant Behavior Analyst

General Provider Information

NPI Number	:	1497272389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER DIAZ

Provider Business Mailing Address
First Line	:	539 CASTLEHILL DR
Second Line	:
City	:	WALNUT
State	:	CA
Zip	:	91789-2624
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	145 S FAIRFAX AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-2166
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2017
Last Update Date	:	08/25/2025

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Directions to “ JENNIFER DIAZ ” Practice Location

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