Provider Demographics
NPI:1093246555
Name:KING, DIAMOND AYANA
Entity Type:Individual
Prefix:MS
First Name:DIAMOND
Middle Name:AYANA
Last Name:KING
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 1:2479 ABERDEEN WAY APT 7
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94806-2559
Mailing Address - Country:US
Mailing Address - Phone:510-227-4437
Mailing Address - Fax:
Practice Address - Street 1:2479 ABERDEEN WAY APT 7
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94806-2559
Practice Address - Country:US
Practice Address - Phone:510-227-4437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-24
Last Update Date:2023-09-07
Deactivation Date:2023-08-17
Deactivation Code:
Reactivation Date:2023-08-31
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No172V00000XOther Service ProvidersCommunity Health Worker