Provider Demographics
NPI:1912767310
Name:ANDRADE, DIANA ABIGAIL (BS)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:ABIGAIL
Last Name:ANDRADE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 W MIDWAY DR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-6507
Mailing Address - Country:US
Mailing Address - Phone:714-517-7107
Mailing Address - Fax:
Practice Address - Street 1:131 W MIDWAY DR
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-6507
Practice Address - Country:US
Practice Address - Phone:714-517-7107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171400000XOther Service ProvidersHealth & Wellness Coach