Randolph, Diana Marie

Randolph, Diana Marie is an individual health care provider with primary practice located at 1124 N Sandalwood Ave , Rialto CA 92376-3848. She recently has only one registered license in Behavioral Health & Social Service Providers / School, which is considered as her primary health care specialty. Randolph, Diana Marie can be contacted via phone (909) 838-6408.

Contact Information

Primary practice address
1124 N Sandalwood Ave Rialto CA 92376-3848
Phone: (909) 838-6408
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / School 101YS0200X
Behavioral Health & Social Service Providers / School 101YS0200X XXXXXXXXXX California

Profile Details

NPI number 1366950032
LBN Legal business name Randolph, Diana Marie
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 16th, 2018
Last updated Jun 16th, 2018 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1366950032 NPPES
California Other 6990202 KAISER

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