Provider Demographics
NPI:1639485113
Name:DIAMANTE, JENNIFER SAHAGUN (RPH)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:SAHAGUN
Last Name:DIAMANTE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9064 HAYVENHURST AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-3600
Mailing Address - Country:US
Mailing Address - Phone:818-895-4728
Mailing Address - Fax:
Practice Address - Street 1:12739 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-1627
Practice Address - Country:US
Practice Address - Phone:818-890-1506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59222183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist