Individual
MRS. ALISA SUZANNE DIETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A., B.C.B.A.
Contact information
Practice address
2670 N MAIN ST, SUITE 305, SANTA ANA, CA 92705-6639
(310) 856-0800
Mailing address
2670 N MAIN ST, SUITE 305, SANTA ANA, CA 92705-6639
(310) 856-0800
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-16-21833
CA
Other
Enumeration date
03/31/2016
Last updated
03/31/2016
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