Provider Demographics
NPI:1316683097
Name:DIAZ, FERNANDO (MPH)
Entity type:Individual
Prefix:
First Name:FERNANDO
Middle Name:
Last Name:DIAZ
Suffix:
Gender:M
Credentials:MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26569 COMMUNITY CENTER DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-6712
Mailing Address - Country:US
Mailing Address - Phone:909-838-4750
Mailing Address - Fax:
Practice Address - Street 1:26569 COMMUNITY CENTER DR
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-6712
Practice Address - Country:US
Practice Address - Phone:909-838-4750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No171M00000XOther Service ProvidersCase Manager/Care Coordinator