Healthcare Provider Details

I. General information

NPI: 1629917471
Provider Name (Legal Business Name): ESTIBALIZ DIAZ APCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7363 HYANNIS CT
RIVERSIDE CA
92506-6174
US

IV. Provider business mailing address

7363 HYANNIS CT
RIVERSIDE CA
92506-6174
US

V. Phone/Fax

Practice location:
  • Phone: 951-768-6811
  • Fax:
Mailing address:
  • Phone: 951-768-6811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC20599
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: