Healthcare Provider Details

I. General information

NPI: 1831037571
Provider Name (Legal Business Name): ELIJAH JESUSA DIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20428 BALTAR ST
WINNETKA CA
91306-1806
US

IV. Provider business mailing address

20428 BALTAR ST
WINNETKA CA
91306-1806
US

V. Phone/Fax

Practice location:
  • Phone: 818-399-5834
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number301484
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: