Provider Demographics
NPI:1518287408
Name:DIAMOND, CHITRA (LVN AA)
Entity Type:Individual
Prefix:MISS
First Name:CHITRA
Middle Name:
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:LVN AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 SYLVIA WAY
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-3144
Mailing Address - Country:US
Mailing Address - Phone:415-444-5594
Mailing Address - Fax:
Practice Address - Street 1:204 SYLVIA WAY
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-3144
Practice Address - Country:US
Practice Address - Phone:415-444-5594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN49259164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse