Healthcare Provider Details

I. General information

NPI: 1568267136
Provider Name (Legal Business Name): VALERIE DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10888 MAPLE AVE
BLOOMINGTON CA
92316-2621
US

IV. Provider business mailing address

18612 SANTA ANA AVE
BLOOMINGTON CA
92316-2636
US

V. Phone/Fax

Practice location:
  • Phone: 909-421-7120
  • Fax: 909-421-7128
Mailing address:
  • Phone: 909-421-7120
  • Fax: 909-421-7128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: