Healthcare Provider Details

I. General information

NPI: 1881299634
Provider Name (Legal Business Name): ASHLEY KARLYNN DIAZ DELEON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2020
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 E 4TH ST STE 107
SANTA ANA CA
92705-3818
US

IV. Provider business mailing address

2130 E 4TH ST STE 107
SANTA ANA CA
92705-3818
US

V. Phone/Fax

Practice location:
  • Phone: 714-361-4386
  • Fax: 714-361-4377
Mailing address:
  • Phone: 714-361-4386
  • Fax: 714-361-4377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: