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General NPI Number Information
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NPI Number | 1477756690
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Entity Type | Individual
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Provider Name | BRENDA MARIA DIAZ M.S., MFT INTERN
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Gender | Female
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Dates
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Enumeration Date | 06/06/2007
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Last Update Date | 05/05/2017
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Provider Practice Location Address
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Address Line | 1126 N GRAND AVE SUITE D
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City | COVINA
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State | CA
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Zip | 91724-1551
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Country | US
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Telephone | 619-436-8268
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Fax |
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Provider Business Mailing Address
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Address Line | 1126 N GRAND AVE SUITE D
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City | COVINA
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State | CA
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Zip | 91724-1551
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Country | US
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Telephone | 619-436-8268
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT99479
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License Number State | CA
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