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General NPI Number Information
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NPI Number | 1528077898
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Entity Type | Individual
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Provider Name | LANCE WOLFE DIAMOND PTA
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Gender | Male
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4700 NORTHGATE BLVD
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City | SACRAMENTO
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State | CA
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Zip | 95834-1128
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Country | US
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Telephone | 916-923-4442
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Fax |
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Provider Business Mailing Address
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Address Line | 1913 BELCOT RD
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City | SACRAMENTO
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State | CA
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Zip | 95825-1106
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Country | US
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Telephone | 916-979-9877
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 6627
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License Number State | CA
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