Healthcare Provider Details

I. General information

NPI: 1730308149
Provider Name (Legal Business Name): ELENA DIANA INZUNZA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3075 MYERS ST
RIVERSIDE CA
92503-5525
US

IV. Provider business mailing address

769 W BLAINE ST STE B
RIVERSIDE CA
92507-3970
US

V. Phone/Fax

Practice location:
  • Phone: 951-358-6895
  • Fax: 951-358-6176
Mailing address:
  • Phone: 951-358-4705
  • Fax: 951-358-4719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW79294
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: