Provider Demographics
NPI:1134671597
Name:TA, DIANA U
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:U
Last Name:TA
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 1:2670 S WHITE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-2073
Mailing Address - Country:US
Mailing Address - Phone:408-937-1558
Mailing Address - Fax:408-516-0053
Practice Address - Street 1:2203 TULLY RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-1348
Practice Address - Country:US
Practice Address - Phone:408-937-1553
Practice Address - Fax:408-937-1548
Is Sole Proprietor?:No
Enumeration Date:2016-11-01
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator