Provider Demographics
NPI:1922242080
Name:DIAMOND, ALBERT DANIEL
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:DANIEL
Last Name:DIAMOND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3625 MISSION AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-2954
Mailing Address - Country:US
Mailing Address - Phone:916-481-3042
Mailing Address - Fax:916-481-3044
Practice Address - Street 1:3625 MISSION AVE
Practice Address - Street 2:SUITE E
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-2954
Practice Address - Country:US
Practice Address - Phone:916-481-3042
Practice Address - Fax:916-481-3044
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACOAFS-05-381623225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist