Provider Demographics
NPI:1447637517
Name:ENERIZ-CHAMPION, DIANALUCY
Entity type:Individual
Prefix:
First Name:DIANALUCY
Middle Name:
Last Name:ENERIZ-CHAMPION
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIANALUCY
Other - Middle Name:
Other - Last Name:ENERIZ-REBOLLEDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3402 HIGHWOOD CT APT 165
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-5382
Mailing Address - Country:US
Mailing Address - Phone:818-590-0449
Mailing Address - Fax:
Practice Address - Street 1:19040 SOLEDAD CANYON RD STE 260
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91351-3363
Practice Address - Country:US
Practice Address - Phone:661-505-8415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-28
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA56CCOtherASPIRANET