Individual
JAIRO DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2180 JOHNSON AVE, SAN LUIS OBISPO, CA 93401-4558
(805) 458-5755
Mailing address
1986 BRIGHTON AVE, GROVER BEACH, CA 93433-1816
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT41795
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
CA
Other
Enumeration date
05/03/2018
Last updated
01/15/2026
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