Provider Demographics
NPI:1508151788
Name:DIAZ, ALEJANDRA (PSYD)
Entity type:Individual
Prefix:DR
First Name:ALEJANDRA
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:ALEJANDRA
Other - Middle Name:
Other - Last Name:DIAZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:1264 PASEO AZUL WAY
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-8502
Mailing Address - Country:US
Mailing Address - Phone:562-537-6435
Mailing Address - Fax:
Practice Address - Street 1:686 E MILL ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92415-3820
Practice Address - Country:US
Practice Address - Phone:909-798-8452
Practice Address - Fax:909-798-8453
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 29041103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical