Provider Demographics
NPI:1174659163
Name:SAMUEL, DIANA (BA)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 18558
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90018
Mailing Address - Country:US
Mailing Address - Phone:323-999-2404
Mailing Address - Fax:323-999-2414
Practice Address - Street 1:5420 NORTH FIGUEROA STREET
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042
Practice Address - Country:US
Practice Address - Phone:323-999-2404
Practice Address - Fax:323-999-2414
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health