1437759198 NPI number — KYMBERLY DIAZ

Table of content: KYMBERLY DIAZ (NPI 1437759198)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437759198 NPI number — KYMBERLY DIAZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIAZ
Provider First Name:
KYMBERLY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437759198
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
85 E. RAMONA EXPRESSWAY, SUITE 1-3 PERRIS, CA 92571
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PERRIS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92571-1720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-349-4195
Provider Business Mailing Address Fax Number:
951-530-5945

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
85 RAMONA EXPY STE 13
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PERRIS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92571-7014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-349-4195
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/30/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X , with the licence number: 115246 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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