Provider Demographics
NPI:1710160551
Name:SAKS TALBOT, DIANE ELLLEN
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:ELLLEN
Last Name:SAKS TALBOT
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 1:2811 LIHOLANI ST
Mailing Address - Street 2:23
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-8400
Mailing Address - Country:US
Mailing Address - Phone:808-573-0450
Mailing Address - Fax:
Practice Address - Street 1:1063 LOWER MAIN ST
Practice Address - Street 2:C-215
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-2038
Practice Address - Country:US
Practice Address - Phone:808-242-5768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-16
Last Update Date:2007-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2286172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist