Provider Demographics
NPI:1841798998
Name:CABALAR, DIANE CHRISTI GO (BSN, RN)
Entity type:Individual
Prefix:
First Name:DIANE CHRISTI
Middle Name:GO
Last Name:CABALAR
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:DIANE CHRISTI
Other - Middle Name:GO
Other - Last Name:VIDAMO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:16349 SYLVANWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-6939
Mailing Address - Country:US
Mailing Address - Phone:818-217-7673
Mailing Address - Fax:
Practice Address - Street 1:16349 SYLVANWOOD AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-6939
Practice Address - Country:US
Practice Address - Phone:818-217-7673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-23
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA742728163WG0000X, 163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA742728OtherBOARD OF REGISTERED NURSING