Basic Information
Provider Information
NPI: 1225210727
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MURRAY
FirstName: DIANNA
MiddleName: MAY
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2416 S MAIN ST
Address2:  
City: SANTA ANA
State: CA
PostalCode: 927073290
CountryCode: US
TelephoneNumber: 7149669999
FaxNumber: 7149669996
Practice Location
Address1: 2416 S MAIN ST
Address2:  
City: SANTA ANA
State: CA
PostalCode: 927073290
CountryCode: US
TelephoneNumber: 7149669999
FaxNumber: 7149669996
Other Information
ProviderEnumerationDate: 11/27/2007
LastUpdateDate: 12/24/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YA0400XRS1024CAY Behavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)

No ID Information.


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