Individual
JACOB DANIEL DIAZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
11666 INWOOD DR, RIVERSIDE, CA 92503-5057
(951) 727-6249
Mailing address
11666 INWOOD DR, RIVERSIDE, CA 92503-5057
(951) 727-6249
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000052865
CA
Other
Enumeration date
06/23/2025
Last updated
06/23/2025
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