Individual
AUDREA A DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1323 W COLTON AVE STE 100, REDLANDS, CA 92374-2853
(909) 335-7067
(909) 792-2045
Mailing address
PO BOX 7369, REDLANDS, CA 92375-0369
(909) 335-7067
(909) 792-2045
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
RW0772
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4739
SIMON STAFF NUMBER
CA
Enumeration date
05/25/2007
Last updated
07/08/2007
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