Healthcare Provider Details

I. General information

NPI: 1578825303
Provider Name (Legal Business Name): DIANA P JORDAN LLOYD LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2012
Last Update Date: 12/16/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 UTICA AVE STE 155
RANCHO CUCAMONGA CA
91730-7605
US

IV. Provider business mailing address

3125 MYERS ST
RIVERSIDE CA
92503-5527
US

V. Phone/Fax

Practice location:
  • Phone: 909-255-0440
  • Fax:
Mailing address:
  • Phone: 951-358-4840
  • Fax: 951-358-4848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number95984
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: