Healthcare Provider Details

I. General information

NPI: 1316405509
Provider Name (Legal Business Name): CASSANDRA GUADALUPE DIAZ MS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2019
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28999 OLD TOWN FRONT ST STE 101
TEMECULA CA
92590-2842
US

IV. Provider business mailing address

28999 OLD TOWN FRONT ST STE 101
TEMECULA CA
92590-2842
US

V. Phone/Fax

Practice location:
  • Phone: 951-212-5199
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT159633
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: