Provider Demographics
NPI:1922572932
Name:DIAZ, CARLA (FNP, NP-C)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:FNP, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16209 EAGLERIDGE CT
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-6504
Mailing Address - Country:US
Mailing Address - Phone:925-681-8986
Mailing Address - Fax:
Practice Address - Street 1:741 S ORANGE AVE STE 150
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2662
Practice Address - Country:US
Practice Address - Phone:626-899-4573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95010192363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily