Provider Demographics
NPI:1891553715
Name:ACOSTA, BRIANNA DIAMOND
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:DIAMOND
Last Name:ACOSTA
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 1:1127 WEST FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-2507
Mailing Address - Country:US
Mailing Address - Phone:323-215-9013
Mailing Address - Fax:
Practice Address - Street 1:1127 WEST FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-2507
Practice Address - Country:US
Practice Address - Phone:323-215-9013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor