Healthcare Provider Details

I. General information

NPI: 1114803178
Provider Name (Legal Business Name): DIANA MAYA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2025
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6736 LAUREL CANYON BLVD STE 200
NORTH HOLLYWOOD CA
91606-1576
US

IV. Provider business mailing address

6636 TUJUNGA AVE APT 2
NORTH HOLLYWOOD CA
91606-1849
US

V. Phone/Fax

Practice location:
  • Phone: 747-252-3859
  • Fax:
Mailing address:
  • Phone: 747-252-3859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW140935
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: