Healthcare Provider Details

I. General information

NPI: 1407253024
Provider Name (Legal Business Name): NANCY DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2014
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 W LA VETA AVE STE 660&470
ORANGE CA
92868-4231
US

IV. Provider business mailing address

1120 W LA VETA AVE STE 660&470
ORANGE CA
92868-4231
US

V. Phone/Fax

Practice location:
  • Phone: 714-509-8210
  • Fax:
Mailing address:
  • Phone: 714-509-8210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: