Healthcare Provider Details

I. General information

NPI: 1194438663
Provider Name (Legal Business Name): DIANA LETICIA YIDI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2022
Last Update Date: 12/29/2022
Certification Date: 12/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6973 LINDA VISTA RD BLDG C
SAN DIEGO CA
92111-6342
US

IV. Provider business mailing address

1459 EL NIDO DR
CHULA VISTA CA
91915-1415
US

V. Phone/Fax

Practice location:
  • Phone: 858-279-0925
  • Fax:
Mailing address:
  • Phone: 619-791-6512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number110300
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: