Basic Information
| Provider Information | |||||||||
| NPI: | 1225319171 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DIAZ | ||||||||
| FirstName: | IRAIS | ||||||||
| MiddleName: | OCAMPO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17701 SAN PASQUAL VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | ESCONDIDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920255301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607414300 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 17701 SAN PASQUAL VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | ESCONDIDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920255301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607414300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2011 | ||||||||
| LastUpdateDate: | 12/16/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/16/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225400000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.