Provider Demographics
NPI:1598270175
Name:AUMAVAE, DIANA IVONNE
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:IVONNE
Last Name:AUMAVAE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:DIANA
Other - Middle Name:IVONNE
Other - Last Name:AUMAVAE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4320 E COBBLESTONE DR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7893
Mailing Address - Country:US
Mailing Address - Phone:907-602-5274
Mailing Address - Fax:
Practice Address - Street 1:4320 E COBBLESTONE DR
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7893
Practice Address - Country:US
Practice Address - Phone:907-602-5274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK7249486104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker