Provider Demographics
NPI:1194075663
Name:DIAZ-CEJA, JESUS
Entity type:Individual
Prefix:MR
First Name:JESUS
Middle Name:
Last Name:DIAZ-CEJA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1890 N GAREY AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-2923
Mailing Address - Country:US
Mailing Address - Phone:909-538-4973
Mailing Address - Fax:909-671-4051
Practice Address - Street 1:1890 N GAREY AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-2923
Practice Address - Country:US
Practice Address - Phone:909-538-4973
Practice Address - Fax:909-671-4051
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health