Healthcare Provider Details

I. General information

NPI: 1356758056
Provider Name (Legal Business Name): CHRISTIAN ANTHONY DIAZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 BEVERLY BLVD
LOS ANGELES CA
90057-2220
US

IV. Provider business mailing address

2814 HOPE ST APT A
HUNTINGTON PARK CA
90255-6040
US

V. Phone/Fax

Practice location:
  • Phone: 213-381-0534
  • Fax:
Mailing address:
  • Phone: 323-536-0353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW135323
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: