Healthcare Provider Details

I. General information

NPI: 1760240006
Provider Name (Legal Business Name): SAHARA-LYNN DIOR SKIPPER CADC I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44505 90TH ST W
LANCASTER CA
93536-7705
US

IV. Provider business mailing address

44505 90TH ST W
LANCASTER CA
93536-7705
US

V. Phone/Fax

Practice location:
  • Phone: 661-726-2630
  • Fax:
Mailing address:
  • Phone: 661-726-2630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-DMSEUR
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCI51460626
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCI51460626
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: