Provider Demographics
NPI:1194184473
Name:ANZORA, DIANA JEANNETTE
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:JEANNETTE
Last Name:ANZORA
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 1:6815 EVANS ST
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93552-4126
Mailing Address - Country:US
Mailing Address - Phone:213-806-0225
Mailing Address - Fax:
Practice Address - Street 1:6815 EVANS ST
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93552-4126
Practice Address - Country:US
Practice Address - Phone:213-806-0225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF3325000390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program