MEDICARE: MS. IRENE W DIAMOND

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
1	174400000X	Specialist	31859	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	31859	OTHER	CA	CALIFRONIA MASSAGE THERAPY COUNCIL

General Provider Information

NPI Number	:	1730425117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. IRENE W DIAMOND

Provider Business Mailing Address
First Line	:	1841 LOMBARD ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94123-2909
Country	:	US
Telephone Number	:	415-921-1296
Fax Number	:

Provider Business Practice Location Address
First Line	:	1841 LOMBARD ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94123-2909
Country	:	US
Telephone Number	:	415-921-1296
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2012
Last Update Date	:	12/12/2012

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