Healthcare Provider Details

I. General information

NPI: 1467286302
Provider Name (Legal Business Name): SABRINA JOSEFINA DIAZ-GALLEGOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2024
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41715 ENTERPRISE CIR N STE 106
TEMECULA CA
92590-5623
US

IV. Provider business mailing address

31046 HUMBOLT CT
TEMECULA CA
92591-7046
US

V. Phone/Fax

Practice location:
  • Phone: 888-688-0248
  • Fax:
Mailing address:
  • Phone: 951-764-7252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW124758
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: