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General NPI Number Information
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NPI Number | 1386687655
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Entity Type | Organization
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Legal Business Name | DIANNA L POWELL
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Dates
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Enumeration Date | 06/14/2006
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Last Update Date | 06/13/2008
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Provider Practice Location Address
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Address Line | 544 E WILLIAMS ST
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City | BARSTOW
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State | CA
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Zip | 92311-2941
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Country | US
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Telephone | 760-256-5225
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Fax | 760-255-4647
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Provider Business Mailing Address
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Address Line | 544 E WILLIAMS ST
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City | BARSTOW
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State | CA
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Zip | 92311-2941
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Country | US
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Telephone | 760-256-5225
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Fax | 760-255-4647
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Authorized Official
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Title or Position | OWNER
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Name | MS. DIANNA LYNNE POWELL
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Credential |
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Telephone | 760-256-5225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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