Provider Demographics
NPI:1518542430
Name:ROSEBURR, DIANNA DESHAY (BA)
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:DESHAY
Last Name:ROSEBURR
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5558 CALIFORNIA AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-0706
Mailing Address - Country:US
Mailing Address - Phone:661-326-1577
Mailing Address - Fax:
Practice Address - Street 1:5558 CALIFORNIA AVE STE 400
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0706
Practice Address - Country:US
Practice Address - Phone:661-326-1577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician