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General NPI Number Information
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NPI Number | 1740758721
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Entity Type | Individual
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Provider Name | DIANE GOSS MHRS
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Gender | Female
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Dates
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Enumeration Date | 11/07/2018
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Last Update Date | 10/21/2020
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Provider Practice Location Address
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Address Line | 11151 SUN CENTER DR STE C
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City | RANCHO CORDOVA
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State | CA
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Zip | 95670-6194
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Country | US
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Telephone | 916-273-3389
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Fax |
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Provider Business Mailing Address
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Address Line | 2836 AQUINO DR
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City | SACRAMENTO
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State | CA
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Zip | 95833-1423
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Country | US
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Telephone |
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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