Healthcare Provider Details

I. General information

NPI: 1821906827
Provider Name (Legal Business Name): DIANNA POOLSAWAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10411 DALE AVE
STANTON CA
90680-2505
US

IV. Provider business mailing address

155 COLTRANE CT
IRVINE CA
92617-5353
US

V. Phone/Fax

Practice location:
  • Phone: 714-761-6324
  • Fax:
Mailing address:
  • Phone: 714-761-6324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number39302
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: