Provider Demographics
NPI:1336887074
Name:VALENZUELA, DIANA FERN (LMFT)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:FERN
Last Name:VALENZUELA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2677 N MAIN ST STE 110
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-6663
Mailing Address - Country:US
Mailing Address - Phone:714-274-7577
Mailing Address - Fax:
Practice Address - Street 1:2677 N MAIN ST STE 110
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-6663
Practice Address - Country:US
Practice Address - Phone:714-274-7577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT132601106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist