Healthcare Provider Details

I. General information

NPI: 1003460593
Provider Name (Legal Business Name): LIZBETH DIAZ ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2019
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 E ARROW HWY
POMONA CA
91767-2535
US

IV. Provider business mailing address

5221 ROSEMEAD BLVD APT C
SAN GABRIEL CA
91776-2272
US

V. Phone/Fax

Practice location:
  • Phone: 909-624-1233
  • Fax:
Mailing address:
  • Phone: 626-899-8758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number116984
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: