Provider Demographics
NPI:1386395838
Name:MARTIN DEL CAMPO, DIANA (LMT)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:MARTIN DEL CAMPO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:LEONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:11410 NE 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-3976
Mailing Address - Country:US
Mailing Address - Phone:619-347-6197
Mailing Address - Fax:
Practice Address - Street 1:204 E 25TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3219
Practice Address - Country:US
Practice Address - Phone:619-347-6197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-17
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61232047225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist