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General NPI Number Information
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NPI Number | 1285823195
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Entity Type | Individual
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Provider Name | DIANE M ELLER-BOYKO RN,MSW,LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/16/2007
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Last Update Date | 10/16/2007
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Provider Practice Location Address
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Address Line | 11530 TERRACINA BLVD
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City | REDLANDS
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State | CA
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Zip | 92373-4853
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Country | US
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Telephone | 909-798-1925
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Fax | 951-351-2013
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Provider Business Mailing Address
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Address Line | PO BOX 327
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City | REDLANDS
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State | CA
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Zip | 92373-0121
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Country | US
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Telephone | 909-798-1925
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Fax | 951-351-2013
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS14764
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License Number State | CA
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