Healthcare Provider Details

I. General information

NPI: 1437797438
Provider Name (Legal Business Name): DIANA JASMIN ZING-SANDOVAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2019
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14700 MANZANITA PARK RD
BEAUMONT CA
92223-4724
US

IV. Provider business mailing address

600 N ARROWHEAD AVE
SAN BERNARDINO CA
92401-1164
US

V. Phone/Fax

Practice location:
  • Phone: 951-845-3155
  • Fax: 951-845-8412
Mailing address:
  • Phone: 909-522-4656
  • Fax: 909-763-5525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10820
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: