Healthcare Provider Details

I. General information

NPI: 1518838366
Provider Name (Legal Business Name): KARLA P DIAZ MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 EL CAMINO AVE
SACRAMENTO CA
95821-5611
US

IV. Provider business mailing address

2360 EL CAMINO AVE
SACRAMENTO CA
95821-5611
US

V. Phone/Fax

Practice location:
  • Phone: 916-979-1788
  • Fax:
Mailing address:
  • Phone: 916-979-1788
  • Fax: 916-979-1796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number240225179
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: