Provider Demographics
NPI:1720220700
Name:DIAZ, JANSSEN ESPINO (JD)
Entity Type:Individual
Prefix:MR
First Name:JANSSEN
Middle Name:ESPINO
Last Name:DIAZ
Suffix:
Gender:M
Credentials:JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-1991
Mailing Address - Country:US
Mailing Address - Phone:626-260-3276
Mailing Address - Fax:951-274-9865
Practice Address - Street 1:1777 ATLANTA AVE STE G1
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-7417
Practice Address - Country:US
Practice Address - Phone:951-778-3500
Practice Address - Fax:951-274-9865
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)