Provider Demographics
NPI:1437797438
Name:ZING-SANDOVAL, DIANA JASMIN
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:JASMIN
Last Name:ZING-SANDOVAL
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 1:600 N ARROWHEAD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92401-1164
Mailing Address - Country:US
Mailing Address - Phone:909-522-4656
Mailing Address - Fax:909-763-5525
Practice Address - Street 1:14700 MANZANITA PARK RD
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-4724
Practice Address - Country:US
Practice Address - Phone:951-845-3155
Practice Address - Fax:951-845-8412
Is Sole Proprietor?:No
Enumeration Date:2019-12-20
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA10820101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program