Provider Demographics
NPI:1417558974
Name:DIOSA MARRIAGE AND FAMILY THERAPY PC
Entity Type:Organization
Organization Name:DIOSA MARRIAGE AND FAMILY THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-253-1834
Mailing Address - Street 1:14420 CIVIC DR STE 6
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-2384
Mailing Address - Country:US
Mailing Address - Phone:760-253-1834
Mailing Address - Fax:760-267-9109
Practice Address - Street 1:14420 CIVIC DR STE 6
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-2384
Practice Address - Country:US
Practice Address - Phone:760-253-1834
Practice Address - Fax:760-267-9109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty