Healthcare Provider Details

I. General information

NPI: 1134734841
Provider Name (Legal Business Name): MELODY ANN DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 W ORANGE AVE
ANAHEIM CA
92804-3298
US

IV. Provider business mailing address

2705 W ORANGE AVE
ANAHEIM CA
92804-3298
US

V. Phone/Fax

Practice location:
  • Phone: 714-761-5442
  • Fax:
Mailing address:
  • Phone: 714-761-5442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number98273
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: