Provider Demographics
NPI:1306180468
Name:SILVA, DIANE (LAC)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:SILVA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 SEBASTOPOL AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-6337
Mailing Address - Country:US
Mailing Address - Phone:707-523-3517
Mailing Address - Fax:
Practice Address - Street 1:516 SEBASTOPOL AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-6337
Practice Address - Country:US
Practice Address - Phone:707-523-3517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5350171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist