Healthcare Provider Details

I. General information

NPI: 1548889868
Provider Name (Legal Business Name): DIANA AVALLE PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2020
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10065 OLD GROVE RD STE 101
SAN DIEGO CA
92131-1664
US

IV. Provider business mailing address

1818 W BEVERLY BLVD STE 207
MONTEBELLO CA
90640-3968
US

V. Phone/Fax

Practice location:
  • Phone: 858-480-6553
  • Fax:
Mailing address:
  • Phone: 619-500-4091
  • Fax: 323-597-1046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY31727
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY31727
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: