Provider Demographics
NPI:1255465431
Name:ROSE, DIANE LINARES
Entity Type:Individual
Prefix:MISS
First Name:DIANE
Middle Name:LINARES
Last Name:ROSE
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 1:1440 W. 19TH STREET
Mailing Address - Street 2:APT# A
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90810
Mailing Address - Country:US
Mailing Address - Phone:562-432-7447
Mailing Address - Fax:
Practice Address - Street 1:4920 S. AVALON BLVD.
Practice Address - Street 2:BAART CLINIC
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90011
Practice Address - Country:US
Practice Address - Phone:323-235-5035
Practice Address - Fax:323-235-2023
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)