Healthcare Provider Details

I. General information

NPI: 1043942964
Provider Name (Legal Business Name): CHRISTIAN DIAZ B.A. SOCIAL WORK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3455 PERCY ST
LOS ANGELES CA
90023-1716
US

IV. Provider business mailing address

333 N BREED ST APT 2333
LOS ANGELES CA
90033-1839
US

V. Phone/Fax

Practice location:
  • Phone: 323-268-2100
  • Fax:
Mailing address:
  • Phone: 424-278-0025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW140518
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: