Provider Demographics
NPI:1194289611
Name:SANON, DIANA
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:SANON
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 1:603 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:IMMOKALEE
Mailing Address - State:FL
Mailing Address - Zip Code:34142-2902
Mailing Address - Country:US
Mailing Address - Phone:239-986-5394
Mailing Address - Fax:
Practice Address - Street 1:5220 LEE BLVD
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-1021
Practice Address - Country:US
Practice Address - Phone:239-932-2220
Practice Address - Fax:239-288-0548
Is Sole Proprietor?:No
Enumeration Date:2019-01-29
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician