Individual
CLARISSA ANGIE REYES DIWA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
850 E FOOTHILL BLVD, RIALTO, CA 92376-5230
(909) 421-9302
Mailing address
850 E FOOTHILL BLVD, RIALTO, CA 92376-5230
(909) 421-9302
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
ASW109269
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0012724688
KAISER PERMANENTE
CA
Enumeration date
07/30/2020
Last updated
08/26/2024
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