Provider Demographics
NPI:1255155982
Name:RINCON, DIANA CHRISTINA
Entity type:Individual
Prefix:MS
First Name:DIANA
Middle Name:CHRISTINA
Last Name:RINCON
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 1:10578 CAYUGA AVE
Mailing Address - Street 2:
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-3011
Mailing Address - Country:US
Mailing Address - Phone:818-645-8799
Mailing Address - Fax:
Practice Address - Street 1:13640 ROSCOE BLVD
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-3904
Practice Address - Country:US
Practice Address - Phone:800-464-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW126839104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker