Healthcare Provider Details

I. General information

NPI: 1629381033
Provider Name (Legal Business Name): DIANA POWELL ENZMANN M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANA TERESA POWELL M.A.

II. Dates (important events)

Enumeration Date: 07/15/2010
Last Update Date: 07/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 W OLYMPIC BLVD SUITE#101
LOS ANGELES CA
90036-4667
US

IV. Provider business mailing address

14027 AUBREY RD
BEVERLY HILLS CA
90210-1062
US

V. Phone/Fax

Practice location:
  • Phone: 323-932-5086
  • Fax: 323-932-5472
Mailing address:
  • Phone: 818-728-0202
  • Fax: 818-728-0207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number5591
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: