Basic Information
| Provider Information | |||||||||
| NPI: | 1740545003 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DIAMOND | ||||||||
| FirstName: | DIONNA | ||||||||
| MiddleName: | P | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4441 AUBURN BLVD STE E | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958414139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164735764 | ||||||||
| FaxNumber: | 9164735766 | ||||||||
| Practice Location | |||||||||
| Address1: | 4441 AUBURN BLVD STE E | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958414139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164735764 | ||||||||
| FaxNumber: | 9164735766 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2012 | ||||||||
| LastUpdateDate: | 07/11/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.