Provider Demographics
NPI:1083387716
Name:HUFFORD-GREEN, DIANA DEZUBE
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:DEZUBE
Last Name:HUFFORD-GREEN
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 1:637 BEULAH ST
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2804
Mailing Address - Country:US
Mailing Address - Phone:310-980-2594
Mailing Address - Fax:
Practice Address - Street 1:13251 VENTURA BLVD STE D
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-1838
Practice Address - Country:US
Practice Address - Phone:626-600-6348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer