Provider Demographics
NPI:1508373077
Name:ANGELES, DIANA VANESSA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:VANESSA
Last Name:ANGELES
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 MISSION ST APT 404
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-3075
Mailing Address - Country:US
Mailing Address - Phone:415-716-9070
Mailing Address - Fax:
Practice Address - Street 1:1400 MISSION ST APT 404
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-3075
Practice Address - Country:US
Practice Address - Phone:415-716-9070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-05
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP21998235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist