Provider Demographics
NPI:1154770535
Name:DAVIDOVA, DIANA
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:DAVIDOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 E ALAMEDA AVE
Mailing Address - Street 2:#302
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1500
Mailing Address - Country:US
Mailing Address - Phone:818-653-6689
Mailing Address - Fax:818-842-6689
Practice Address - Street 1:217 E ALAMEDA AVE
Practice Address - Street 2:#302
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1500
Practice Address - Country:US
Practice Address - Phone:818-653-6689
Practice Address - Fax:818-842-6689
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health