Individual
KELLY ETHEL DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
200 FOOTHILL BLVD, LA CANADA, CA 91011-3700
(818) 826-1637
Mailing address
200 FOOTHILL BLVD, LA CANADA, CA 91011-3700
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
004992
NY
2255A2300X
Athletic Trainer
Primary
2000058035
CA
Other
Enumeration date
11/16/2024
Last updated
09/14/2025
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