Provider Demographics
NPI:1629763719
Name:ABUSHAREKH, DIANA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:ABUSHAREKH
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 1:2904 WEALD WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833-3534
Mailing Address - Country:US
Mailing Address - Phone:708-972-4799
Mailing Address - Fax:
Practice Address - Street 1:2904 WEALD WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95833-3534
Practice Address - Country:US
Practice Address - Phone:708-972-4799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician