Individual
DIEGO STREET
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1730 PILOT PEAK AVE, CHULA VISTA, CA 91913-3663
(805) 881-2257
Mailing address
1730 PILOT PEAK AVE, CHULA VISTA, CA 91913-3663
(805) 881-2257
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Y6122559
LICENSE
CA
Enumeration date
01/29/2026
Last updated
01/29/2026
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