Healthcare Provider Details

I. General information

NPI: 1033426374
Provider Name (Legal Business Name): DIANA RABBAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 06/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3845 SPRING DR
SPRING VALLEY CA
91977
US

IV. Provider business mailing address

3845 SPRING DR
SPRING VALLEY CA
91977-1030
US

V. Phone/Fax

Practice location:
  • Phone: 619-515-2380
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number34427
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number72987
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: