Healthcare Provider Details

I. General information

NPI: 1912325051
Provider Name (Legal Business Name): DIANA CAROLINA CANTERO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2014
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27235 TOURNEY RD STE 2500
VALENCIA CA
91355-5908
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 661-253-5851
  • Fax:
Mailing address:
  • Phone: 310-301-8707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA51693
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: