Provider Demographics
NPI:1912885245
Name:PASERO, DIAMOND
Entity type:Individual
Prefix:
First Name:DIAMOND
Middle Name:
Last Name:PASERO
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 1:4030 E MORADA LN APT 7101
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95212-1644
Mailing Address - Country:US
Mailing Address - Phone:702-808-8393
Mailing Address - Fax:
Practice Address - Street 1:105 S SAN JOAQUIN ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-3206
Practice Address - Country:US
Practice Address - Phone:209-953-5466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker