Provider Demographics
NPI:1467147728
Name:DIAZ NAVARRETE, ALFREDO MIGUEL
Entity type:Individual
Prefix:
First Name:ALFREDO
Middle Name:MIGUEL
Last Name:DIAZ NAVARRETE
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:PO BOX 484
Mailing Address - Street 2:
Mailing Address - City:NILAND
Mailing Address - State:CA
Mailing Address - Zip Code:92257-0484
Mailing Address - Country:US
Mailing Address - Phone:442-270-0548
Mailing Address - Fax:
Practice Address - Street 1:18 E 1ST STREET
Practice Address - Street 2:
Practice Address - City:NILAND
Practice Address - State:CA
Practice Address - Zip Code:92257
Practice Address - Country:US
Practice Address - Phone:442-270-0548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-11
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician