Provider Demographics
NPI:1013196849
Name:TAYLOR, DIANNA SANDRA
Entity Type:Individual
Prefix:MRS
First Name:DIANNA
Middle Name:SANDRA
Last Name:TAYLOR
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 1:35292 PORTOLA PL
Mailing Address - Street 2:
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-7984
Mailing Address - Country:US
Mailing Address - Phone:951-894-5779
Mailing Address - Fax:
Practice Address - Street 1:6355 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3163
Practice Address - Country:US
Practice Address - Phone:951-369-5714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health