Provider Demographics
NPI:1851925416
Name:DIAMOND, GABRIEL A (MA 00004282)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:A
Last Name:DIAMOND
Suffix:
Gender:M
Credentials:MA 00004282
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13332 BAGLEY AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-7825
Mailing Address - Country:US
Mailing Address - Phone:206-861-6977
Mailing Address - Fax:
Practice Address - Street 1:13332 BAGLEY AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-7825
Practice Address - Country:US
Practice Address - Phone:206-861-6977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-23
Last Update Date:2020-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00004282225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist