Individual
FREDY JESUS DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
PO BOX 6609, BIG BEAR LAKE, CA 92315-6609
(909) 878-2326
Mailing address
1019 SIERRA AVE, BIG BEAR CITY, CA 92314-9779
(909) 521-5709
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
CA
175T00000X
Peer Specialist
MPSS-HFEGQM
CA
Other
Enumeration date
11/26/2024
Last updated
12/04/2025
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