Healthcare Provider Details

I. General information

NPI: 1538803531
Provider Name (Legal Business Name): DIANE SELINA CORDOVA MA, AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2022
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

658 E BRIER DR STE 150
SAN BERNARDINO CA
92408-2875
US

IV. Provider business mailing address

2500 E FOOTHILL BLVD STE 300
PASADENA CA
91107-7102
US

V. Phone/Fax

Practice location:
  • Phone: 909-501-0700
  • Fax:
Mailing address:
  • Phone: 626-993-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT132452
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: