Provider Demographics
NPI:1992241376
Name:STROTHER, DIANE
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:STROTHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDHAP
Mailing Address - Street 1:13900 HIGH FALLS TRL
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-5633
Mailing Address - Country:US
Mailing Address - Phone:310-634-8183
Mailing Address - Fax:
Practice Address - Street 1:13900 HIGH FALLS TRL
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-5633
Practice Address - Country:US
Practice Address - Phone:310-634-8183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAP604124Q00000X
CARDH13827124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist