MEDICARE: KAITLIN CHRISTINA DIAZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	ASW132068	CA

General Provider Information

NPI Number	:	1255066528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLIN CHRISTINA DIAZ

Provider Business Mailing Address
First Line	:	12580 LAKELAND RD
Second Line	:
City	:	SANTA FE SPRINGS
State	:	CA
Zip	:	90670-3940
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	615 W CIVIC CENTER DR
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92701-4006
Country	:	US
Telephone Number	:	714-795-3444
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2022
Last Update Date	:	12/10/2025

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