Healthcare Provider Details

I. General information

NPI: 1376278879
Provider Name (Legal Business Name): ELIDIA ROMERO-DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 N EUCLID AVE
ONTARIO CA
91762-2729
US

IV. Provider business mailing address

855 N EUCLID AVE
ONTARIO CA
91762-2729
US

V. Phone/Fax

Practice location:
  • Phone: 909-983-2020
  • Fax: 909-983-6847
Mailing address:
  • Phone: 909-983-2020
  • Fax: 909-983-6847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: