=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396873121
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELIZABETH DIAZ-AMBRIZ LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2007
-----------------------------------------------------
Last Update Date | 08/14/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6 CENTERPOINTE DR STE 700
-----------------------------------------------------
City | LA PALMA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90623-2545
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-454-6563
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 CENTERPOINTE DR STE 700
-----------------------------------------------------
City | LA PALMA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90623-2545
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-454-6563
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 53125
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------