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NPI Code Detail

MEDICARE: MS. DIANA SAMUEL BA

MEDICARE: MS. DIANA SAMUEL BA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1174659163
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DIANA SAMUEL BA
Provider Business Mailing Address
First Line : PO BOX 18558
Second Line :
City : LOS ANGELES
State : CA
Zip : 90018
Country : US
Telephone Number : 323-999-2404
Fax Number : 323-999-2414
Provider Business Practice Location Address
First Line : 5420 NORTH FIGUEROA STREET
Second Line :
City : LOS ANGELES
State : CA
Zip : 90042
Country : US
Telephone Number : 323-999-2404
Fax Number : 323-999-2414
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2007
Last Update Date : 07/08/2007

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