Healthcare Provider Details

I. General information

NPI: 1013346493
Provider Name (Legal Business Name): MARIA DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2013
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12450 VAN NUYS BLVD 200
PACOIMA CA
91331-1391
US

IV. Provider business mailing address

12450 VAN NUYS BLVD STE 200
PACOIMA CA
91331-1393
US

V. Phone/Fax

Practice location:
  • Phone: 818-896-1161
  • Fax: 818-896-5069
Mailing address:
  • Phone: 818-896-1161
  • Fax: 818-896-5069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: