Provider Demographics
NPI:1689876302
Name:ALI, DIANA S (PHD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:S
Last Name:ALI
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 1:119 FIGUEROA ST STE 7
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-2756
Mailing Address - Country:US
Mailing Address - Phone:626-590-2972
Mailing Address - Fax:
Practice Address - Street 1:119 FIGUEROA ST STE 7
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-2756
Practice Address - Country:US
Practice Address - Phone:626-590-2972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2022-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 26034103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical