Provider Demographics
NPI:1982392502
Name:DIAZ, SONIA MARIA (PPS, MA, LMFT)
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:MARIA
Last Name:DIAZ
Suffix:
Gender:F
Credentials:PPS, MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 WASHINGTON ST # 423
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2110
Mailing Address - Country:US
Mailing Address - Phone:714-595-3136
Mailing Address - Fax:
Practice Address - Street 1:C A PUNTA BANDA 31A
Practice Address - Street 2:CAMPO TURISTICO PLAYA DORADA
Practice Address - City:ENSENADA
Practice Address - State:BAJA CALIFORNA
Practice Address - Zip Code:22794
Practice Address - Country:MX
Practice Address - Phone:646-154-2645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA98659101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health