Provider Demographics
NPI:1497429369
Name:VARELA, DIANA MICHELL
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:MICHELL
Last Name:VARELA
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 1:16600 DOWNEY AVE SPC 164
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-6235
Mailing Address - Country:US
Mailing Address - Phone:424-219-3099
Mailing Address - Fax:
Practice Address - Street 1:225 S LAKE AVE STE 300
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-3009
Practice Address - Country:US
Practice Address - Phone:626-432-7270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA106S00000XOtherBEHAVIOR TECHNICIAN