Provider Demographics
NPI:1952023566
Name:ALEJANDRE DIAZ, LAURA ANGELICA
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ANGELICA
Last Name:ALEJANDRE DIAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26864 TROPICANA DR
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92585-9094
Mailing Address - Country:US
Mailing Address - Phone:562-547-0597
Mailing Address - Fax:
Practice Address - Street 1:26864 TROPICANA DR
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92585-9094
Practice Address - Country:US
Practice Address - Phone:562-547-0597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA7525814347C00000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle