Healthcare Provider Details

I. General information

NPI: 1184589640
Provider Name (Legal Business Name): MAYRA ELIZABETH DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 YOUNG ST UNIT STE 400
BAKERSFIELD CA
93311-8896
US

IV. Provider business mailing address

5701 YOUNG ST UNIT STE 400
BAKERSFIELD CA
93311-8896
US

V. Phone/Fax

Practice location:
  • Phone: 833-831-8946
  • Fax: 661-865-0472
Mailing address:
  • Phone: 833-831-8946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: