Healthcare Provider Details

I. General information

NPI: 1548356884
Provider Name (Legal Business Name): WU & DIAZ PROFESSIONAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 E PHILADELPHIA STREET SUITE # 150
ONTARIO CA
91761
US

IV. Provider business mailing address

3550 E PHILADELPHIA STREET SUITE # 150
ONTARIO CA
91761
US

V. Phone/Fax

Practice location:
  • Phone: 909-773-0022
  • Fax: 866-672-8222
Mailing address:
  • Phone: 909-773-0022
  • Fax: 866-672-8222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A8127
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA69486
License Number StateCA

VIII. Authorized Official

Name: JACK X WU
Title or Position: SECRETARY
Credential: MD
Phone: 909-773-0022