Provider Demographics
NPI:1497980593
Name:MADRIGAL-MUNOZ, DIANNA
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:
Last Name:MADRIGAL-MUNOZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 S BEACH BLVD APT D
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-5143
Mailing Address - Country:US
Mailing Address - Phone:562-505-1810
Mailing Address - Fax:
Practice Address - Street 1:1202 W CIVIC CENTER DR
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-2252
Practice Address - Country:US
Practice Address - Phone:714-245-0045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical