Healthcare Provider Details

I. General information

NPI: 1689984361
Provider Name (Legal Business Name): MS. MARIA GUADALUPE DIAZ-GUEVARA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GUADALUPE DIAZ GUEVARA LUPE DIAZ

II. Dates (important events)

Enumeration Date: 10/15/2010
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804 PARK COURT PLACE SUITE H
SANTA ANA CA
92701
US

IV. Provider business mailing address

1801 PARK COURT PL BLDG H
SANTA ANA CA
92701-5028
US

V. Phone/Fax

Practice location:
  • Phone: 714-957-1004
  • Fax: 714-550-9658
Mailing address:
  • Phone: 714-371-6082
  • Fax: 714-730-8212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberCA
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: