Healthcare Provider Details

I. General information

NPI: 1043175706
Provider Name (Legal Business Name): DIANA PEROVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CREEKSIDE RIDGE CT # 215
ROSEVILLE CA
95678-3595
US

IV. Provider business mailing address

101 CREEKSIDE RIDGE CT # 215
ROSEVILLE CA
95678-3595
US

V. Phone/Fax

Practice location:
  • Phone: 916-256-2652
  • Fax:
Mailing address:
  • Phone: 916-256-2652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberNO
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: