Healthcare Provider Details

I. General information

NPI: 1871274498
Provider Name (Legal Business Name): ALISIA DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 E 7TH ST
MADERA CA
93638-3780
US

IV. Provider business mailing address

209 E 7TH ST
MADERA CA
93638-3780
US

V. Phone/Fax

Practice location:
  • Phone: 559-673-3508
  • Fax:
Mailing address:
  • Phone: 559-673-3508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: