Individual
CHRISTINA DIAZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2220 GIRARD ST, SAN JACINTO, CA 92583-5301
(951) 683-6596
Mailing address
2220 GIRARD STREET, SAN JACINTO, CA 92583
(951) 683-6596
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
R1222720216
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TINA3003
BEHAVIORAL HEALTH
CA
Enumeration date
02/13/2017
Last updated
02/13/2017
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