Provider Demographics
NPI:1154792034
Name:VERA, DIANE
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:VERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:P
Other - Last Name:VERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:44123 61ST ST W
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-1705
Mailing Address - Country:US
Mailing Address - Phone:661-992-8469
Mailing Address - Fax:
Practice Address - Street 1:44123 61ST ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-1705
Practice Address - Country:US
Practice Address - Phone:661-992-8469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-17
Last Update Date:2015-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst