Provider Demographics
NPI:1740849967
Name:YASHAR, DIANA MARJAN
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:MARJAN
Last Name:YASHAR
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 1:8542 SATURN ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-3619
Mailing Address - Country:US
Mailing Address - Phone:310-497-5467
Mailing Address - Fax:
Practice Address - Street 1:1959 KINGSDALE AVE
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-3417
Practice Address - Country:US
Practice Address - Phone:310-214-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2020-07-08
Deactivation Date:2019-10-29
Deactivation Code:
Reactivation Date:2020-01-09
Provider Licenses
StateLicense IDTaxonomies
GAF01190884363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily