Individual provider Active NPI

Stephanie Diaz, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Covina, CA
National Provider Identifier
1699313296
Registry record updated Sep 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
NP95035542 Issued in CA
Practice address
1359 N Grand Ave
Covina, CA 91724-1016
Phone
(626) 430-2900
NPI assigned
Dec 13, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 4, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NP95035542 CA Primary
Registered Nurse 163W00000X 795985 CA

Addresses

Primary practice location

1359 N Grand Ave
Covina, CA 91724-1016

Mailing address

1359 N Grand Ave
Covina, CA 91724-1016
Phone (909) 376-0065

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260106002688 CA Practitioner - Nurse Practitioner 3173019577 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1359 N Grand Ave
1St FL
Covina, CA 91724-1016

510 S Vermont Ave
19TH FL
Los Angeles, CA 90020-1992

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
795985CAMDRegistered Nurse
NP95035542CAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Los Angeles County Department of Mental Health CurrentSince Oct 10, 2025 Accepting new patients
Los Angeles County Department of Mental Health CurrentSince Oct 10, 2025 Accepting new patients

Locations

330 E Live Oak Ave
Arcadia, CA 91006
Phone (626) 254-1400

1359 N Grand Ave
Covina, CA 91724
Phone (626) 430-2900

349A E Avenue K6
Lancaster, CA 93535
Phone (661) 723-4260

510 S Vermont Ave
Fl 19
Los Angeles, CA 90020
Phone (213) 480-3416

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1576195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756944000000",
    "number": "1699313296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1359 N GRAND AVE",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917241016",
            "telephone_number": "909-376-0065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1359 N GRAND AVE",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917241016",
            "telephone_number": "626-430-2900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIAZ",
        "first_name": "STEPHANIE",
        "credential": "PMHNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-12-13",
        "last_updated": "2025-09-04",
        "certification_date": "2025-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "NP95035542",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "795985",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Covina, CA

Sources for this page

Verify at the official NPI Registry.