Active NPI
Sofia C Diaz, PHD.
- Clinical Psychologist
- Glendale, CA
National Provider Identifier
1104959279
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY22343
- Practice address
- 410 Arden Ave Ste 201
Glendale, CA 91203-4006 - Phone
- (626) 590-0611
- NPI assigned
- Mar 14, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY22343 | CA | Primary |
Addresses
Primary practice location
410 Arden Ave Ste 201
Glendale, CA 91203-4006
Mailing address
PO Box 70384
Pasadena, CA 91117-7384
Other practice location 1
595 E Colorado Blvd
Suite 305
Pasadena, CA 91101-2039
Phone (310) 486-3853
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY22343 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173830400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1618531200000",
"number": "1104959279",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 70384",
"city": "PASADENA",
"state": "CA",
"postal_code": "911177384"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "410 ARDEN AVE STE 201",
"city": "GLENDALE",
"state": "CA",
"postal_code": "912034006",
"telephone_number": "626-590-0611"
}
],
"practiceLocations": [
{
"address_1": "595 E Colorado Blvd",
"address_2": "Suite 305",
"address_purpose": "LOCATION",
"city": "Pasadena",
"state": "CA",
"postal_code": "911012039",
"country_code": "US",
"telephone_number": "310-486-3853",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DIAZ",
"first_name": "SOFIA",
"middle_name": "C",
"name_prefix": "Dr.",
"credential": "PHD.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-14",
"last_updated": "2021-04-16",
"certification_date": "2021-04-16",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY22343",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glendale, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.