Healthcare Provider Details

I. General information

NPI: 1336576628
Provider Name (Legal Business Name): STEPHANIE LANZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2013
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24121 HIGH KNOB RD UNIT F
DIAMOND BAR CA
91765-4265
US

IV. Provider business mailing address

24121 HIGH KNOB RD UNIT F
DIAMOND BAR CA
91765-4265
US

V. Phone/Fax

Practice location:
  • Phone: 909-766-0589
  • Fax:
Mailing address:
  • Phone: 909-766-0589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT106859
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: