Provider Demographics
NPI:1700959004
Name:PATALAGOYTI, DIANA NAIR I (BA)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:NAIR
Last Name:PATALAGOYTI
Suffix:I
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2318 MCGILVRA BLVD E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-2745
Mailing Address - Country:US
Mailing Address - Phone:425-609-5505
Mailing Address - Fax:425-609-5506
Practice Address - Street 1:1031 SE EVERETT MALL WAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-2833
Practice Address - Country:US
Practice Address - Phone:425-609-5505
Practice Address - Fax:425-609-5506
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00055559101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor