MEDICARE: MARANDA L DIAMOND CCC-SLP, TSSLD

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	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1902696313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARANDA L DIAMOND CCC-SLP, TSSLD

Provider Business Mailing Address
First Line	:	7300 W SUNSET BLVD, LOS ANGELES, CA 90046
Second Line	:	APT 9
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7300 W SUNSET BLVD, LOS ANGELES, CA 90046
Second Line	:	APT 2
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90038
Country	:	US
Telephone Number	:	323-285-2283
Fax Number	:

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

Provider Enumeration Date	:	05/08/2025
Last Update Date	:	05/08/2025

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