Healthcare Provider Details

I. General information

NPI: 1417830332
Provider Name (Legal Business Name): ERIK VALDEZ-DIAZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2025
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 W 6TH ST STE 205
SAN PEDRO CA
90732-3567
US

IV. Provider business mailing address

1301 PINE AVE STE 205
LONG BEACH CA
90813-3124
US

V. Phone/Fax

Practice location:
  • Phone: 310-833-3135
  • Fax: 310-707-2877
Mailing address:
  • Phone: 562-595-1159
  • Fax: 562-486-4661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number165071
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: