Healthcare Provider Details

I. General information

NPI: 1801791942
Provider Name (Legal Business Name): MARIBEL MEDINA DIAZ LPT NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2182 CHESTNUT AVE
LONG BEACH CA
90806-4508
US

IV. Provider business mailing address

2182 CHESTNUT AVE
LONG BEACH CA
90806-4508
US

V. Phone/Fax

Practice location:
  • Phone: 562-225-3328
  • Fax:
Mailing address:
  • Phone: 562-225-3328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License NumberPT43384
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: