Provider Demographics
NPI:1942862701
Name:BAKER, DIANA BOSTICK
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:BOSTICK
Last Name:BAKER
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 1:15625 NW 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:OPA LOCKA
Mailing Address - State:FL
Mailing Address - Zip Code:33054-2268
Mailing Address - Country:US
Mailing Address - Phone:305-302-9373
Mailing Address - Fax:305-693-9427
Practice Address - Street 1:15625 NW 27TH AVE
Practice Address - Street 2:
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33054-2268
Practice Address - Country:US
Practice Address - Phone:305-302-9373
Practice Address - Fax:305-693-9427
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty