Healthcare Provider Details

I. General information

NPI: 1538726765
Provider Name (Legal Business Name): CLAUDIA DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2019
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1033
WALNUT CA
91788-1033
US

IV. Provider business mailing address

PO BOX 1033
WALNUT CA
91788-1033
US

V. Phone/Fax

Practice location:
  • Phone: 909-510-3880
  • Fax:
Mailing address:
  • Phone: 909-510-3880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW117114
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: