Provider Demographics
NPI:1629381033
Name:ENZMANN, DIANA POWELL (MA)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:POWELL
Last Name:ENZMANN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:DIANA
Other - Middle Name:TERESA
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:14027 AUBREY RD
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-1062
Mailing Address - Country:US
Mailing Address - Phone:818-728-0202
Mailing Address - Fax:818-728-0207
Practice Address - Street 1:5901 W OLYMPIC BLVD
Practice Address - Street 2:SUITE#101
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4667
Practice Address - Country:US
Practice Address - Phone:323-932-5086
Practice Address - Fax:323-932-5472
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5591235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist