Provider Demographics
NPI:1952088064
Name:DILES, CLAUDE III (CMPSS)
Entity Type:Individual
Prefix:MR
First Name:CLAUDE
Middle Name:
Last Name:DILES
Suffix:III
Gender:M
Credentials:CMPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 PALO VERDE AVE STE 251
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-3322
Mailing Address - Country:US
Mailing Address - Phone:424-242-3087
Mailing Address - Fax:
Practice Address - Street 1:5150 CANDLEWOOD ST STE 22C
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-1929
Practice Address - Country:US
Practice Address - Phone:424-242-3087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-29
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
CAMPSS-LKXQFH175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No172V00000XOther Service ProvidersCommunity Health Worker