Healthcare Provider Details

I. General information

NPI: 1639626344
Provider Name (Legal Business Name): CRISTINA DIAZ REICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRISTINA DIAZ

II. Dates (important events)

Enumeration Date: 09/10/2016
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E CHAPMAN AVE STE 203
FULLERTON CA
92831-3846
US

IV. Provider business mailing address

PO BOX 9
FULLERTON CA
92836-0009
US

V. Phone/Fax

Practice location:
  • Phone: 714-680-9000
  • Fax:
Mailing address:
  • Phone: 714-680-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number130536
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4801
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: