Healthcare Provider Details

I. General information

NPI: 1669710521
Provider Name (Legal Business Name): MS. SANDRA AW DIAMOND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. SANDRA ALLISON WARSHAW

II. Dates (important events)

Enumeration Date: 01/27/2013
Last Update Date: 02/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N EUCLID ST SUITE 300
ANAHEIM CA
92801-5506
US

IV. Provider business mailing address

20381 MANSARD LN
HUNTINGTON BEACH CA
92646-5136
US

V. Phone/Fax

Practice location:
  • Phone: 714-871-5646
  • Fax: 714-817-7368
Mailing address:
  • Phone: 949-614-3520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: