Healthcare Provider Details

I. General information

NPI: 1689933665
Provider Name (Legal Business Name): NYDIA DIAZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2012
Last Update Date: 05/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13960 LANNING DR
WHITTIER CA
90605-2633
US

IV. Provider business mailing address

13960 LANNING DR
WHITTIER CA
90605-2633
US

V. Phone/Fax

Practice location:
  • Phone: 562-682-1026
  • Fax:
Mailing address:
  • Phone: 562-682-1026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number263761
License Number StateCA

VIII. Authorized Official

Name: NYDIA DIAZ
Title or Position: NURSE
Credential: LVN
Phone: 562-682-1026