Healthcare Provider Details

I. General information

NPI: 1508596362
Provider Name (Legal Business Name): DANIELA JANEL DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45180 CLUB DR
INDIAN WELLS CA
92210-8806
US

IV. Provider business mailing address

32640 CIELO VISTA RD
CATHEDRAL CITY CA
92234-9396
US

V. Phone/Fax

Practice location:
  • Phone: 760-354-8285
  • Fax:
Mailing address:
  • Phone: 760-898-1239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-88906
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: