Provider Demographics
NPI:1427655034
Name:DIAKOVA, SVETLANA (CMT)
Entity type:Individual
Prefix:
First Name:SVETLANA
Middle Name:
Last Name:DIAKOVA
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:LANA
Other - Middle Name:
Other - Last Name:DIAKOVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CMT
Mailing Address - Street 1:3030 SUNCREST DR UNIT 604
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-1542
Mailing Address - Country:US
Mailing Address - Phone:858-888-6638
Mailing Address - Fax:
Practice Address - Street 1:3030 SUNCREST DR UNIT 604
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-1542
Practice Address - Country:US
Practice Address - Phone:858-888-6638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58777225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist