Healthcare Provider Details

I. General information

NPI: 1558730689
Provider Name (Legal Business Name): DIANA URENA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DIANA RODRIGUEZ

II. Dates (important events)

Enumeration Date: 09/18/2015
Last Update Date: 01/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9650 ZELZAH AVE
NORTHRIDGE CA
91325-2003
US

IV. Provider business mailing address

110 S GARFIELD AVE
MONTEBELLO CA
90640-3810
US

V. Phone/Fax

Practice location:
  • Phone: 818-993-9311
  • Fax:
Mailing address:
  • Phone: 323-869-9255
  • Fax: 323-869-9241

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 Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: