Provider Demographics
NPI:1245029123
Name:ULLOA-MONTES, DIANA IVETTE
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:IVETTE
Last Name:ULLOA-MONTES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 LELAND ST
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-4819
Mailing Address - Country:US
Mailing Address - Phone:619-668-5720
Mailing Address - Fax:
Practice Address - Street 1:1001 LELAND ST
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-4819
Practice Address - Country:US
Practice Address - Phone:619-668-5720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230071244101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool