Provider Demographics
NPI:1417687971
Name:PALOMO DIAZ, ASHLEY ELIZABETH (MED)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ELIZABETH
Last Name:PALOMO DIAZ
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:985 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-1273
Mailing Address - Country:US
Mailing Address - Phone:909-343-9221
Mailing Address - Fax:
Practice Address - Street 1:21801 CACTUS AVE STE A
Practice Address - Street 2:
Practice Address - City:MARCH ARB
Practice Address - State:CA
Practice Address - Zip Code:92518-3020
Practice Address - Country:US
Practice Address - Phone:833-526-2333
Practice Address - Fax:855-621-9293
Is Sole Proprietor?:No
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1679041495Medicaid