Healthcare Provider Details

I. General information

NPI: 1134082134
Provider Name (Legal Business Name): OSCAR EDWARD DIAZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31850 SAN ELJAY AVE
CATHEDRAL CTY CA
92234-3243
US

IV. Provider business mailing address

31850 SAN ELJAY AVE
CATHEDRAL CTY CA
92234-3243
US

V. Phone/Fax

Practice location:
  • Phone: 760-422-7060
  • Fax:
Mailing address:
  • Phone: 760-422-7060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: