Healthcare Provider Details

I. General information

NPI: 1104419019
Provider Name (Legal Business Name): JASMINE TATIANA DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2021
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 OAK GROVE RD
CONCORD CA
94518-3225
US

IV. Provider business mailing address

80 WISTERIA CT
OAKLEY CA
94561-4174
US

V. Phone/Fax

Practice location:
  • Phone: 925-655-1502
  • Fax:
Mailing address:
  • Phone: 925-625-1938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: