Provider Demographics
NPI:1740758721
Name:GOSS, DIANE (MHRS)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:
Last Name:GOSS
Suffix:
Gender:F
Credentials:MHRS
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:RILEY-GOSS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2836 AQUINO DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833-1423
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11151 SUN CENTER DR STE C
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-6194
Practice Address - Country:US
Practice Address - Phone:916-273-3389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant