Healthcare Provider Details

I. General information

NPI: 1053064584
Provider Name (Legal Business Name): DIANA GISELLE ARMENTA OLMOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2022
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 FOLSOM ST
SAN FRANCISCO CA
94107-1243
US

IV. Provider business mailing address

3219 HELENE CT
CONCORD CA
94518-1129
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax:
Mailing address:
  • Phone: 818-522-5624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: