Provider Demographics
NPI:1720970346
Name:AVALOS, DIANA LAURA
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:LAURA
Last Name:AVALOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 RODEO DR UNIT 513
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:CA
Mailing Address - Zip Code:92251-2083
Mailing Address - Country:US
Mailing Address - Phone:760-925-9967
Mailing Address - Fax:
Practice Address - Street 1:1000 RODEO DR UNIT 513
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:CA
Practice Address - Zip Code:92251-2083
Practice Address - Country:US
Practice Address - Phone:760-925-9967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst