Basic Information
| Provider Information | |||||||||
| NPI: | 1275664500 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GONZALEZ | ||||||||
| FirstName: | DIANNA | ||||||||
| MiddleName: | MARISOL | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2601 AIRPORT DR | ||||||||
| Address2: | 135 | ||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905056140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4242011600 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2601 AIRPORT DR | ||||||||
| Address2: | 135 | ||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905056140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4242011600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2007 | ||||||||
| LastUpdateDate: | 05/20/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | IMF52865 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 103TC1900X | PSY26893 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Counseling |
No ID Information.