Healthcare Provider Details

I. General information

NPI: 1932047297
Provider Name (Legal Business Name): MARICHEL EMMYTH DIAZ PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20150 MAYHALL DR
WILDOMAR CA
92595-8272
US

IV. Provider business mailing address

35708 WOSHKA LN
WILDOMAR CA
92595-9569
US

V. Phone/Fax

Practice location:
  • Phone: 951-253-7630
  • Fax: 951-253-7631
Mailing address:
  • Phone: 951-805-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number240192710
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: