Provider Demographics
NPI:1346790458
Name:RAMIREZ-DIAZ, ANGELICA (LMFT)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:
Last Name:RAMIREZ-DIAZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:ANGELICA
Other - Middle Name:
Other - Last Name:RAMIREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19322 JESSE LN STE 200
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-5072
Mailing Address - Country:US
Mailing Address - Phone:951-387-4040
Mailing Address - Fax:951-398-3144
Practice Address - Street 1:19322 JESSE LN STE 200
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-5072
Practice Address - Country:US
Practice Address - Phone:951-387-4040
Practice Address - Fax:951-398-3144
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-12
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103776101Y00000X
101Y00000X
CA122193106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor