Healthcare Provider Details

I. General information

NPI: 1588349104
Provider Name (Legal Business Name): DIANA JANE BACSAFRA LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83844 HOPI AVE
INDIO CA
92203-2638
US

IV. Provider business mailing address

83844 HOPI AVE
INDIO CA
92203-2638
US

V. Phone/Fax

Practice location:
  • Phone: 760-398-9000
  • Fax:
Mailing address:
  • Phone: 760-393-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number721982
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: