Individual
AILENE JENET DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4334 LATHAM ST, RIVERSIDE, CA 92501-1748
(951) 961-8282
Mailing address
322 COYOTE DR, COLTON, CA 92324-3721
(909) 254-8381
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
501588
CA
Other
Enumeration date
12/29/2023
Last updated
12/29/2023
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