Provider Demographics
NPI:1144808874
Name:JAIME PIZANO, DIANA
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:JAIME PIZANO
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:PO BOX 897
Mailing Address - Street 2:
Mailing Address - City:SOLEDAD
Mailing Address - State:CA
Mailing Address - Zip Code:93960-0897
Mailing Address - Country:US
Mailing Address - Phone:831-756-6466
Mailing Address - Fax:
Practice Address - Street 1:256 GABILAN DR
Practice Address - Street 2:
Practice Address - City:SOLEDAD
Practice Address - State:CA
Practice Address - Zip Code:93960-2557
Practice Address - Country:US
Practice Address - Phone:831-756-6466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst