Healthcare Provider Details

I. General information

NPI: 1720679335
Provider Name (Legal Business Name): DIANNA TRINISHA FORTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39115 TRADE CENTER DR
PALMDALE CA
93551-3649
US

IV. Provider business mailing address

39115 TRADE CENTER DR
PALMDALE CA
93551-3649
US

V. Phone/Fax

Practice location:
  • Phone: 213-393-1538
  • Fax:
Mailing address:
  • Phone: 213-393-1538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number121007
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: