Provider Demographics
NPI:1154052074
Name:SORIANO-LANSMAN, DIANA C (APCC)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:C
Last Name:SORIANO-LANSMAN
Suffix:
Gender:F
Credentials:APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4929 N WINERY CIR APT 106
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-1533
Mailing Address - Country:US
Mailing Address - Phone:559-287-7290
Mailing Address - Fax:
Practice Address - Street 1:4141 N BLACKSTONE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-3808
Practice Address - Country:US
Practice Address - Phone:559-712-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CAAPCC10552101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAPCC10552OtherBOARD OF BEHAVIORAL HEALTH