Healthcare Provider Details

I. General information

NPI: 1033886007
Provider Name (Legal Business Name): ELIZABETH DIAZ GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21545 CENTRE POINTE PKWY
SANTA CLARITA CA
91350-2947
US

IV. Provider business mailing address

21545 CENTRE POINTE PKWY
SANTA CLARITA CA
91350-2947
US

V. Phone/Fax

Practice location:
  • Phone: 661-259-9439
  • Fax:
Mailing address:
  • Phone: 661-259-9439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number146989
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: