Provider Demographics
NPI:1922544675
Name:DIAMOND, LACEE (MS, ATC, MBA)
Entity Type:Individual
Prefix:
First Name:LACEE
Middle Name:
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:MS, ATC, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LMU DR
Mailing Address - Street 2:GERSTEN PAVILLION
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-2650
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 LMU DR
Practice Address - Street 2:GERSTEN PAVILLION
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-2650
Practice Address - Country:US
Practice Address - Phone:310-338-2764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer