Provider Demographics
NPI:1205415551
Name:STAUBER, DIANE TOSHIYE (LVN)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:TOSHIYE
Last Name:STAUBER
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1985 PENNGROVE ST
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-2373
Mailing Address - Country:US
Mailing Address - Phone:805-558-8586
Mailing Address - Fax:
Practice Address - Street 1:SAN FERNANDO VALLEY COMMUNITY MENTAL HEALTH CENTER
Practice Address - Street 2:16360 ROSCOE BLVD
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406
Practice Address - Country:US
Practice Address - Phone:818-901-4830
Practice Address - Fax:818-901-8985
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA225400000X
CAVN225233164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner