Healthcare Provider Details

I. General information

NPI: 1437759198
Provider Name (Legal Business Name): KYMBERLY DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2020
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 RAMONA EXPY STE 13
PERRIS CA
92571-7014
US

IV. Provider business mailing address

85 E. RAMONA EXPRESSWAY, SUITE 1-3 PERRIS, CA 92571
PERRIS CA
92571-1720
US

V. Phone/Fax

Practice location:
  • Phone: 951-349-4195
  • Fax:
Mailing address:
  • Phone: 951-349-4195
  • Fax: 951-530-5945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number115246
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: