Healthcare Provider Details

I. General information

NPI: 1306518881
Provider Name (Legal Business Name): NOHEMI DIAZ LPCC, LEP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27193 WOODGLEN LN
MORENO VALLEY CA
92555-4534
US

IV. Provider business mailing address

PO BOX 7571
MORENO VALLEY CA
92552-7571
US

V. Phone/Fax

Practice location:
  • Phone: 323-519-2482
  • Fax:
Mailing address:
  • Phone: 323-519-2482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number18865
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number4252
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: