Provider Demographics
NPI:1346035573
Name:DIAMOND, BIANCA
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:
Last Name:DIAMOND
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14725 SE RHONE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-2556
Mailing Address - Country:US
Mailing Address - Phone:503-666-6575
Mailing Address - Fax:503-491-3395
Practice Address - Street 1:14725 SE RHONE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97236-2556
Practice Address - Country:US
Practice Address - Phone:503-666-6575
Practice Address - Fax:503-491-3395
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist