Healthcare Provider Details

I. General information

NPI: 1437288990
Provider Name (Legal Business Name): DIANA MARI LE BLANC PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 N C ST
LOMPOC CA
93436-3438
US

IV. Provider business mailing address

1212 N C ST
LOMPOC CA
93436-3438
US

V. Phone/Fax

Practice location:
  • Phone: 530-591-5326
  • Fax:
Mailing address:
  • Phone: 530-591-5326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number230101582
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: