Provider Demographics
NPI:1427625615
Name:SAMBULA, DIANA MARIBEL
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:MARIBEL
Last Name:SAMBULA
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 1:642 GROVE ST FL 1
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-3717
Mailing Address - Country:US
Mailing Address - Phone:917-530-8051
Mailing Address - Fax:
Practice Address - Street 1:642 GROVE ST FL 1
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-3717
Practice Address - Country:US
Practice Address - Phone:917-530-8051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator