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General NPI Number Information
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NPI Number | 1568357093
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Entity Type | Individual
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Provider Name | MALLORY DIAZ
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Gender | Female
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Dates
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Enumeration Date | 06/12/2025
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 1295 CORONA POINTE CT STE 102
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City | CORONA
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State | CA
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Zip | 92879-1721
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Country | US
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Telephone | 625-249-4714
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Fax |
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Provider Business Mailing Address
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Address Line | 6524 ARABIS PL
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91739-1573
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Country | US
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Telephone | 951-751-7891
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | 2378
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License Number State | CA
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