Provider Demographics
NPI:1831590728
Name:RICHARDSON, DIANA CAROLINA (BA)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:CAROLINA
Last Name:RICHARDSON
Suffix:
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 1:29039 POPPY MEADOW ST
Mailing Address - Street 2:29039 POPPY MEADOW STREET
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91387-1895
Mailing Address - Country:US
Mailing Address - Phone:661-476-8222
Mailing Address - Fax:
Practice Address - Street 1:29039 POPPY MEADOW ST
Practice Address - Street 2:29039 POPPY MEADOW STREET
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91387-1895
Practice Address - Country:US
Practice Address - Phone:661-476-8222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program