Provider Demographics
NPI:1306224183
Name:MINA, MARIA DIANA
Entity Type:Individual
Prefix:
First Name:MARIA DIANA
Middle Name:
Last Name:MINA
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 1:32443 ROMAN WARREN WAY
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:CA
Mailing Address - Zip Code:92596-7603
Mailing Address - Country:US
Mailing Address - Phone:951-445-3634
Mailing Address - Fax:
Practice Address - Street 1:32443 ROMAN WARREN WAY
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:CA
Practice Address - Zip Code:92596-7603
Practice Address - Country:US
Practice Address - Phone:951-445-3634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-12
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3129224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant