Healthcare Provider Details

I. General information

NPI: 1770127375
Provider Name (Legal Business Name): NAYELI DIANE DE LA PAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2019
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 E BONITA AVE STE 101
POMONA CA
91767-1923
US

IV. Provider business mailing address

255 E BONITA AVE STE 101
POMONA CA
91767-1923
US

V. Phone/Fax

Practice location:
  • Phone: 909-593-7437
  • Fax: 909-593-0318
Mailing address:
  • Phone: 909-593-7437
  • Fax: 909-593-0318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA57690
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: