Provider Demographics
NPI:1669189585
Name:DIAZ, MARTHA CATALINA (LMFT)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:CATALINA
Last Name:DIAZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5929 W 77TH PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-2934
Mailing Address - Country:US
Mailing Address - Phone:310-621-6097
Mailing Address - Fax:
Practice Address - Street 1:5929 W 77TH PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-2934
Practice Address - Country:US
Practice Address - Phone:310-621-6097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50570106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist