1780790485 NPI number — MS. DIANA ROSE IRVING MSW, LCSW

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780790485 NPI number — MS. DIANA ROSE IRVING MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IRVING
Provider First Name:
DIANA
Provider Middle Name:
ROSE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EDGAR
Provider Other First Name:
DIANA
Provider Other Middle Name:
ROSE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW, LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780790485
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P. O. BOX 1296
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BANNING
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92220-1934
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-392-0632
Provider Business Mailing Address Fax Number:
888-850-7657

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
126 AVOCADO AVE
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
PERRIS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92571-2605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-392-0632
Provider Business Practice Location Address Fax Number:
888-850-7657
Provider Enumeration Date:
08/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCS 11054 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: HR2892 . This is a "MEDICARE PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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