Healthcare Provider Details

I. General information

NPI: 1275287062
Provider Name (Legal Business Name): ISAAC DIAZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2022
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 MORENA BLVD SUT 100
SAN DIEGO CA
91110
US

IV. Provider business mailing address

1260 MORENA BLVD SUT 100
SAN DIEGO CA
91110
US

V. Phone/Fax

Practice location:
  • Phone: 619-398-0355
  • Fax:
Mailing address:
  • Phone: 619-398-0355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: