Provider Demographics
NPI:1275664500
Name:GONZALEZ, DIANNA MARISOL (PHD)
Entity Type:Individual
Prefix:MISS
First Name:DIANNA
Middle Name:MARISOL
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 AIRPORT DR
Mailing Address - Street 2:135
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6140
Mailing Address - Country:US
Mailing Address - Phone:424-201-1600
Mailing Address - Fax:
Practice Address - Street 1:2601 AIRPORT DR
Practice Address - Street 2:135
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6140
Practice Address - Country:US
Practice Address - Phone:424-201-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF52865106H00000X
CAPSY26893103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist