MEDICARE: DR. ALEJANDRA DIAZ PSYD

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	103TC0700X	Clinical Psychologist	PSY 29041	CA

General Provider Information

NPI Number	:	1508151788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEJANDRA DIAZ PSYD

Provider Business Mailing Address
First Line	:	1264 PASEO AZUL WAY
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92879-8502
Country	:	US
Telephone Number	:	562-537-6435
Fax Number	:

Provider Business Practice Location Address
First Line	:	686 E MILL ST
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92415-3820
Country	:	US
Telephone Number	:	909-798-8452
Fax Number	:	909-798-8453

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

Provider Enumeration Date	:	06/15/2011
Last Update Date	:	06/30/2025

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