Healthcare Provider Details

I. General information

NPI: 1942172531
Provider Name (Legal Business Name): CRYSTAL DIAZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2025
Last Update Date: 04/18/2026
Certification Date: 04/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1278 E LATHAM AVE
HEMET CA
92543-4445
US

IV. Provider business mailing address

2876 VIOLET DR
SAN JACINTO CA
92582-3737
US

V. Phone/Fax

Practice location:
  • Phone: 951-925-6625
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95038230
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: