Provider Demographics
NPI:1811876113
Name:NAVARRO-DECIERDO, DIANA (PPS CREDENTIAL)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:NAVARRO-DECIERDO
Suffix:
Gender:F
Credentials:PPS CREDENTIAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W ELDER ST
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-2870
Mailing Address - Country:US
Mailing Address - Phone:760-695-9825
Mailing Address - Fax:
Practice Address - Street 1:400 W ELDER ST
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-2870
Practice Address - Country:US
Practice Address - Phone:760-695-9825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA220163880101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool