Provider Demographics
NPI:1114931904
Name:SANCHEZ, DIANA GRACIELA (PT)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:GRACIELA
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 E LOS ANGELES AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-7706
Mailing Address - Country:US
Mailing Address - Phone:805-390-6709
Mailing Address - Fax:805-527-4882
Practice Address - Street 1:495 E LOS ANGELES AVE STE 104
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-7706
Practice Address - Country:US
Practice Address - Phone:805-390-6709
Practice Address - Fax:805-527-4882
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT21371225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist