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General NPI Number Information
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NPI Number | 1255693461
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Entity Type | Individual
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Provider Name | DIANA BAILEY-TUDER CMT
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Gender | Female
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Dates
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Enumeration Date | 06/13/2012
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Last Update Date | 06/13/2012
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Provider Practice Location Address
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Address Line | 149 AVENIDA GRANADA FL 2
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-4055
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Country | US
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Telephone | 949-303-8233
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Fax |
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Provider Business Mailing Address
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Address Line | 2813 VIA MONTECITO
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-3623
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Country | US
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Telephone | 949-303-8233
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number | 25001
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License Number State | CA
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