Provider Demographics
NPI:1124215009
Name:SCOFIELD, DIANE DEE
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:DEE
Last Name:SCOFIELD
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 1:921 MACINAW RD
Mailing Address - Street 2:#2
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-3525
Mailing Address - Country:US
Mailing Address - Phone:530-541-5440
Mailing Address - Fax:530-541-0456
Practice Address - Street 1:921 MACINAW RD
Practice Address - Street 2:#2
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-3525
Practice Address - Country:US
Practice Address - Phone:530-541-5440
Practice Address - Fax:530-541-0456
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility